Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 614038 | TX |
NPI | 1013053099 |
---|---|
Provider Name | Sandi Marie Brunello |
First Address | Nashville, TN 37201-1826 |
Second Address | Houston, TX 77005-2537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 16/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177224601 | (05) | TX |
8N9259 | BLUE CROSS (01) | TX |
Q56248 | (02) | TX |