Healthcare Provider Details

I. General information

NPI: 1063855914
Provider Name (Legal Business Name): PATRICIA MARIE BRUNETTE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S 10TH ST UNIT 1
MILWAUKEE WI
53221-2412
US

IV. Provider business mailing address

4800 S 10TH ST UNIT 1
MILWAUKEE WI
53221-2412
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-5370
  • Fax: 414-744-9052
Mailing address:
  • Phone: 414-744-5370
  • Fax: 414-744-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number94233-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: