Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 017125 | LA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 61-17296 | LA |
NPI | 1184616112 |
---|---|
Provider Name | Ms. Joan Elizabeth Brunson |
First Address | Alexandria, LA 71301-8131 |
Second Address | Alexandria, LA 71301-8131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080169582 | RAILROAD MEDICARE (01) | |
1337820 | (05) | LA |
720477182 | VARIOUS INSURANCES (01) | |
B62184 | (02) |