Healthcare Provider Details

I. General information

NPI: 1083742142
Provider Name (Legal Business Name): STEPHEN MICHAEL BRUDNEY CASE MANAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

538 HILLER RD
MCKINLEYVILLE CA
95519-3337
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax:
Mailing address:
  • Phone: 707-840-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNONE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: