Healthcare Provider Details

I. General information

NPI: 1093153728
Provider Name (Legal Business Name): EVE SOLANGE BRUNEAU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HIGHWAY 491 NORTH
SHIPROCK NM
87420
US

IV. Provider business mailing address

11657 ROAD 27.1
DOLORES CO
81323-9247
US

V. Phone/Fax

Practice location:
  • Phone: 917-837-4535
  • Fax:
Mailing address:
  • Phone: 917-837-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS018694
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0065562
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: