Provider Demographics
NPI:1174384929
Name:WNUK, BRETT ALEXANDRA (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:ALEXANDRA
Last Name:WNUK
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:BRETT
Other - Middle Name:ALEXANDRA
Other - Last Name:GRANBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1181 TRINITY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7091
Mailing Address - Country:US
Mailing Address - Phone:919-500-6137
Mailing Address - Fax:
Practice Address - Street 1:852 GOLD HILL RD STE 204
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6965
Practice Address - Country:US
Practice Address - Phone:803-228-4038
Practice Address - Fax:866-884-5371
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMW8605808363LP0808X
SCMW8805597363LP0808X
SC28376363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health