Healthcare Provider Details

I. General information

NPI: 1649597121
Provider Name (Legal Business Name): KELLY ANN BRUNE ADN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 PACIFIC AVE 7TH FLOOR
EVERETT WA
98201-4147
US

IV. Provider business mailing address

PO BOX 34439
SEATTLE WA
98124-1439
US

V. Phone/Fax

Practice location:
  • Phone: 425-303-6545
  • Fax: 425-303-6550
Mailing address:
  • Phone: 425-317-0279
  • Fax: 425-317-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN00105350
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: