MEDICARE: AMY N BRUNSVOLD NP

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	363L00000X	Nurse Practitioner	RN111410	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558343012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY N BRUNSVOLD NP

Provider Business Mailing Address
First Line	:	81 W ESPERANZA BLVD
Second Line	:	STE 201
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-2667
Country	:	US
Telephone Number	:	520-625-4401
Fax Number	:	520-625-8504

Provider Business Practice Location Address
First Line	:	15921 W AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85735
Country	:	US
Telephone Number	:	520-822-2335
Fax Number	:	520-822-2362

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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