MEDICARE: PAULA CONAWAY BRUNER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	101108	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2750596E	OTHER	NC	MEDICARE NUMBER

General Provider Information

NPI Number	:	1144212507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA CONAWAY BRUNER PA

Provider Business Mailing Address
First Line	:	1202 MEDICAL CENTER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7307
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:	910-341-3321

Provider Business Practice Location Address
First Line	:	1300 BRIDGE BARRIER RD STE 2
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3939
Country	:	US
Telephone Number	:	910-458-4101
Fax Number	:	910-458-5617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/05/2014

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Directions to “ PAULA CONAWAY BRUNER PA” Practice Location

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