Healthcare Provider Details

I. General information

NPI: 1043146376
Provider Name (Legal Business Name): HAILEY BRUNELLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 S LEFT FORK HOBBLE CREEK CYN
SPRINGVILLE UT
84663-6165
US

IV. Provider business mailing address

5500 MING AVE STE 410
BAKERSFIELD CA
93309-4631
US

V. Phone/Fax

Practice location:
  • Phone: 385-500-3529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number104901303102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: