MEDICARE: LAURA J BRUNSEN MD

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	207Q00000X	Family Medicine Physician	32131	IA

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	:	1790794337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA J BRUNSEN MD

Provider Business Mailing Address
First Line	:	1215 DUFF AVE
Second Line	:
City	:	AMES
State	:	IA
Zip	:	50010-5469
Country	:	US
Telephone Number	:	515-239-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 WASHINGTON AVE STE A
Second Line	:
City	:	IOWA FALLS
State	:	IA
Zip	:	50126-2102
Country	:	US
Telephone Number	:	641-648-2586
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/02/2023

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