Provider Demographics
NPI:1487368775
Name:BRUNGARDT, ANTONETTE B (DNP, APRN)
Entity type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:B
Last Name:BRUNGARDT
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 E MURDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3003
Mailing Address - Country:US
Mailing Address - Phone:316-685-7234
Mailing Address - Fax:316-685-0317
Practice Address - Street 1:3232 E MURDOCK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3003
Practice Address - Country:US
Practice Address - Phone:316-685-7234
Practice Address - Fax:316-685-0317
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-111791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily