1003022401 NPI number — CYNTHIA R BRUNE MS ART THERAPY

Table of content: CYNTHIA R BRUNE MS ART THERAPY (NPI 1003022401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003022401 NPI number — CYNTHIA R BRUNE MS ART THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNE
Provider First Name:
CYNTHIA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS ART THERAPY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003022401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4851 S HATLEY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUDAHY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-294-9348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 W SILVER SPRING E
Provider Second Line Business Practice Location Address:
WING A3 WILLOWGLEN THERAPY ASSOCIATES
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-527-6970
Provider Business Practice Location Address Fax Number:
414-527-6971
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 221700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43712100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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