Healthcare Provider Details

I. General information

NPI: 1710434055
Provider Name (Legal Business Name): DONNA BRUNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2016
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 W SAHARA AVE STE 150
LAS VEGAS NV
89117
US

IV. Provider business mailing address

7380 W SAHARA AVE STE 150
LAS VEGAS NV
89117-2762
US

V. Phone/Fax

Practice location:
  • Phone: 725-333-2411
  • Fax: 702-952-5257
Mailing address:
  • Phone: 725-333-2411
  • Fax: 702-952-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2018026578
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201801732NPPP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60838569
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number825045
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5803
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8279-33
License Number StateWI
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP132667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: