Healthcare Provider Details

I. General information

NPI: 1144212507
Provider Name (Legal Business Name): PAULA CONAWAY BRUNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA ELIZABETH CONAWAY PA C

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BRIDGE BARRIER RD STE 2
CAROLINA BEACH NC
28428-3939
US

IV. Provider business mailing address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 910-458-4101
  • Fax: 910-458-5617
Mailing address:
  • Phone: 910-341-3300
  • Fax: 910-341-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101108
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: