Healthcare Provider Details

I. General information

NPI: 1487026241
Provider Name (Legal Business Name): KATHERINE BRUNCK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2023
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE ML 2023
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4371
  • Fax: 513-636-7657
Mailing address:
  • Phone: 513-636-4371
  • Fax: 513-636-7657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.019375
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN.352141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: