MEDICARE: MRS. JOYCE MARGARET BRUN

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	172A00000X	Driver		OH
2	3747P1801X	Personal Care Attendant		OH

General Provider Information

NPI Number	:	1730928722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOYCE MARGARET BRUN

Provider Business Mailing Address
First Line	:	562 W ALEX BELL RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-3050
Country	:	US
Telephone Number	:	937-609-4090
Fax Number	:

Provider Business Practice Location Address
First Line	:	562 W ALEX BELL RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-3050
Country	:	US
Telephone Number	:	937-609-4090
Fax Number	:

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

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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