1700921079 NPI number — MRS. JENNIFER SUZANNE BRUNS

Table of content: MRS. JENNIFER SUZANNE BRUNS (NPI 1700921079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700921079 NPI number — MRS. JENNIFER SUZANNE BRUNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNS
Provider First Name:
JENNIFER
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEEMS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700921079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 DELAWARE ST APT 42
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94702-1472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-981-0525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 ARNOLD DR STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94553-6537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-229-5400
Provider Business Practice Location Address Fax Number:
925-229-5406
Provider Enumeration Date:
02/21/2007

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: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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