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General NPI Number Information
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NPI Number | 1891776993
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Entity Type | Individual
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Provider Name | KIRSTIN ELLEN BRUNNER DO
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Gender | Female
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1020 EAST 1OTH STREET
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City | ERIE
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State | PA
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Zip | 16503-0002
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Country | US
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Telephone | 814-453-4309
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Fax | 814-459-1191
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Provider Business Mailing Address
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Address Line | 5711 LUNA LN
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City | ERIE
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State | PA
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Zip | 16506-4719
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Country | US
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Telephone | 814-453-4309
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | OS006234L
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License Number State | PA
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