Provider Demographics
NPI:1174029789
Name:BRUNER, AMELIA S (RN)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:S
Last Name:BRUNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7990 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7790
Mailing Address - Country:US
Mailing Address - Phone:619-599-6637
Mailing Address - Fax:
Practice Address - Street 1:7990 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7790
Practice Address - Country:US
Practice Address - Phone:619-599-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28150408A207Q00000X
IN71008456A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine