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General NPI Number Information
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NPI Number | 1669297776
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Entity Type | Individual
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Provider Name | TRISHELLE BRUNGARD PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 415 17TH AVE N
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City | HOPKINS
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State | MN
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Zip | 55343-7224
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Country | US
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Telephone | 952-931-1276
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Fax |
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Provider Business Mailing Address
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Address Line | 15973 ELMWOOD WAY
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City | APPLE VALLEY
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State | MN
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Zip | 55124-4250
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Country | US
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Telephone | 570-939-7294
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15085
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License Number State | MN
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