MEDICARE: PEARL BRUNETTE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1831235175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARL BRUNETTE

Provider Business Mailing Address
First Line	:	PO BOX 2032
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03302-2032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-3852
Country	:	US
Telephone Number	:	603-225-0123
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	03/31/2016

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Directions to “ PEARL BRUNETTE ” Practice Location

Language	Start Address	Practice Location

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