MEDICARE: SONJA DYANNE BRUNE

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	364S00000X	Clinical Nurse Specialist	553923	TX
2	364SA2100X	Acute Care Clinical Nurse Specialist	AP110040	TX
3	363L00000X	Nurse Practitioner	AP110040	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88N001	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780683888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA DYANNE BRUNE

Provider Business Mailing Address
First Line	:	PO BOX 5730
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 FREDERICKSBURG RD STE 400
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3539
Country	:	US
Telephone Number	:	726-842-9799
Fax Number	:	726-842-9798

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/22/2025

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Directions to “ SONJA DYANNE BRUNE ” Practice Location

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