MEDICARE: JILL K BRUNSTAD PA

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	363A00000X	Physician Assistant	001000611	NC
2	363A00000X	Physician Assistant	2234	WI

General Provider Information

NPI Number	:	1902861131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL K BRUNSTAD PA

Provider Business Mailing Address
First Line	:	302 W PINE ST STE 2
Second Line	:
City	:	EAGLE RIVER
State	:	WI
Zip	:	54521-9349
Country	:	US
Telephone Number	:	715-891-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 W PINE ST STE 2
Second Line	:
City	:	EAGLE RIVER
State	:	WI
Zip	:	54521-9349
Country	:	US
Telephone Number	:	715-891-0088
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	04/10/2024

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Directions to “ JILL K BRUNSTAD PA” Practice Location

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