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NPI Code Detail

MEDICARE: MS. MARY JOAN BRUNNER

MEDICARE: MS. MARY JOAN BRUNNER
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1164647210
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY JOAN BRUNNER
Provider Business Mailing Address
First Line : 201 S WILLIAM ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46601-2515
Country : US
Telephone Number : 574-234-2870
Fax Number : 574-232-2872
Provider Business Practice Location Address
First Line : 201 S WILLIAM ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46601-2515
Country : US
Telephone Number : 574-234-2870
Fax Number : 574-232-2872
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/09/2007

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Directions to “ MS. MARY JOAN BRUNNER ” Practice Location

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