Provider Demographics
NPI:1548995194
Name:BRUNELLO, CARYN
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:BRUNELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12636 IRIS WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7622
Mailing Address - Country:US
Mailing Address - Phone:907-227-3661
Mailing Address - Fax:
Practice Address - Street 1:12636 IRIS WAY
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7622
Practice Address - Country:US
Practice Address - Phone:907-227-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator