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NPI Code Detail

MEDICARE: ANDREA L BRUNSON NP

MEDICARE: ANDREA L BRUNSON 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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP2040AZ
2363L00000XNurse PractitionerAP2040AZ

General Provider Information

NPI Number : 1831209014
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA L BRUNSON NP
Provider Business Mailing Address
First Line : 6677 W THUNDERBIRD RD STE I164
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-3762
Country : US
Telephone Number : 623-878-2100
Fax Number :
Provider Business Practice Location Address
First Line : 6677 W THUNDERBIRD RD STE I164
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-3762
Country : US
Telephone Number : 623-878-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 12/19/2024

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Directions to “ ANDREA L BRUNSON NP” Practice Location

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