Provider Demographics
NPI:1861102477
Name:BRUNER, ERIN SUE (RN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:SUE
Last Name:BRUNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 PAA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5207
Mailing Address - Country:US
Mailing Address - Phone:503-784-3252
Mailing Address - Fax:
Practice Address - Street 1:3507 PAA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-5207
Practice Address - Country:US
Practice Address - Phone:503-784-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1670787163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse