Provider Demographics
NPI:1174137756
Name:BRUNDRETT, STACEY MARIE (CNS)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:BRUNDRETT
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR JOHNSON AFB
Mailing Address - State:NC
Mailing Address - Zip Code:27531
Mailing Address - Country:US
Mailing Address - Phone:919-722-8714
Mailing Address - Fax:
Practice Address - Street 1:2803 MEDICAL CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR JOHNSON AFB
Practice Address - State:NC
Practice Address - Zip Code:27531
Practice Address - Country:US
Practice Address - Phone:919-722-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9630300364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical