Healthcare Provider Details

I. General information

NPI: 1770186587
Provider Name (Legal Business Name): LEE BRUNNGRABER RN, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR BLDG 3
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

2500 HOSPITAL DR BLDG 3
MOUNTAIN VIEW CA
94040-4106
US

V. Phone/Fax

Practice location:
  • Phone: 650-863-9000
  • Fax: 877-991-6283
Mailing address:
  • Phone: 650-863-9000
  • Fax: 877-991-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number268808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: