Healthcare Provider Details

I. General information

NPI: 1750331039
Provider Name (Legal Business Name): JUDITH ANDERSON-BRUNER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 PACHA PKWY SUITE 1
NORTH LIBERTY IA
52317-4797
US

IV. Provider business mailing address

720 PACHA PKWY SUITE 1
NORTH LIBERTY IA
52317-4797
US

V. Phone/Fax

Practice location:
  • Phone: 319-384-8822
  • Fax: 319-339-1449
Mailing address:
  • Phone: 319-384-8822
  • Fax: 319-339-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA052736
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: