MEDICARE: MS. MICHELLE BREUNIG DNP, CNS, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	70000194B	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041-332034	OTHER	IL	REGISTERED PRO. NURSE

General Provider Information

NPI Number	:	1881724730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE BREUNIG DNP, CNS, FNP-C

Provider Business Mailing Address
First Line	:	426 S LAKE ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-2405
Country	:	US
Telephone Number	:	219-939-6070
Fax Number	:	219-939-6090

Provider Business Practice Location Address
First Line	:	426 S LAKE ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-2405
Country	:	US
Telephone Number	:	219-939-6070
Fax Number	:	219-939-6090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	02/16/2024

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