Provider Demographics
NPI:1487168563
Name:RANNETSBERGER BRUNSCHWIG, DANI JO (PA-C)
Entity type:Individual
Prefix:
First Name:DANI
Middle Name:JO
Last Name:RANNETSBERGER BRUNSCHWIG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANI
Other - Middle Name:JO
Other - Last Name:RANNETSBERGER BRUNSCHWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1626 COMMONWEALTH AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5042
Mailing Address - Country:US
Mailing Address - Phone:218-220-0384
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:218-220-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty