Healthcare Provider Details

I. General information

NPI: 1821984253
Provider Name (Legal Business Name): GABRIEL BRUNK APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE STE 211
SPRINGFIELD OH
45504-1853
US

IV. Provider business mailing address

30 W MCCREIGHT AVE STE 211
SPRINGFIELD OH
45504-1853
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-3696
  • Fax: 937-325-3713
Mailing address:
  • Phone: 937-325-3696
  • Fax: 937-325-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0038791
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: