Healthcare Provider Details

I. General information

NPI: 1487217410
Provider Name (Legal Business Name): MRS.MONIQUE BRUNSON CERTIFIED NURSE AID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONA BRUNSON MONA BRUNSON

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 11/23/2023
Certification Date: 11/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10042 EMERALD FOREST DR
HERNANDO MS
38632-6404
US

IV. Provider business mailing address

10042 EMERALD FOREST DR
HERNANDO MS
38632-6404
US

V. Phone/Fax

Practice location:
  • Phone: 662-368-2575
  • Fax: 662-590-0934
Mailing address:
  • Phone: 901-290-2048
  • Fax: 662-590-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number10085872
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number102382
License Number StateTN
# 8
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: