Healthcare Provider Details

I. General information

NPI: 1932056579
Provider Name (Legal Business Name): AMELIA J BRUNNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 KELLY RD
MONITOR WA
98836-5924
US

IV. Provider business mailing address

PO BOX 397
MONITOR WA
98836-0397
US

V. Phone/Fax

Practice location:
  • Phone: 509-669-5425
  • Fax:
Mailing address:
  • Phone: 509-669-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: