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General NPI Number Information
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NPI Number | 1104750561
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Entity Type | Individual
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Provider Name | KIMBERLY BRUENN
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Gender | Female
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 43 GREENWICH AVE
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City | GREENWICH
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State | CT
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Zip | 06830-5510
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Country | US
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Telephone | 203-489-3118
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Fax |
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Provider Business Mailing Address
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Address Line | 26 GAIL CT
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City | CARMEL
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State | NY
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Zip | 10512-3826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17617
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License Number State | CT
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