Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APRN.CNP.0029561 | OH |
NPI | 1023694668 |
---|---|
Provider Name | Kendra Elaine Brunner |
First Address | New Albany, OH 43054-9226 |
Second Address | New Albany, OH 43054-9226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2021 |
Last Update Date | 06/01/2022 |