Healthcare Provider Details

I. General information

NPI: 1376849737
Provider Name (Legal Business Name): SUSAN KS BRUNER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 E SPRINGFIELD AVE SUITE E
SPOKANE WA
99202-2913
US

IV. Provider business mailing address

1817 E SPRINGFIELD AVE SUITE E
SPOKANE WA
99202-2913
US

V. Phone/Fax

Practice location:
  • Phone: 509-262-6406
  • Fax:
Mailing address:
  • Phone: 509-262-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00151042
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00151042
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60211296
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: