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NPI Code Detail

MEDICARE: NICOLE ANN BRUNS MNT

MEDICARE: NICOLE ANN BRUNS MNT
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
1133V00000XRegistered Dietitian4616OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952300147
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ANN BRUNS MNT
Provider Business Mailing Address
First Line : 1012 LONES DR
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-2332
Country : US
Telephone Number : 419-356-7504
Fax Number :
Provider Business Practice Location Address
First Line : 4235 SECOR RD
Second Line :
City : TOLEDO
State : OH
Zip : 43623-4299
Country : US
Telephone Number : 419-469-6884
Fax Number : 888-363-3695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 01/31/2025

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Directions to “ NICOLE ANN BRUNS MNT” Practice Location

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