Provider Demographics
NPI:1023642360
Name:ECLIPSE PSYCHIATRY, PLC
Entity type:Organization
Organization Name:ECLIPSE PSYCHIATRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:BRUNGARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:308-224-4101
Mailing Address - Street 1:5805 I AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8422
Mailing Address - Country:US
Mailing Address - Phone:308-224-4101
Mailing Address - Fax:
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8964
Practice Address - Country:US
Practice Address - Phone:308-224-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)