Provider Demographics
NPI:1073694261
Name:BRUNNER, CATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:160 N MIDLAND AVE
Mailing Address - Street 2:HIGHLAND MEDICAL, PC
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1912
Mailing Address - Country:US
Mailing Address - Phone:845-348-2000
Mailing Address - Fax:845-362-3972
Practice Address - Street 1:974 RTE 45
Practice Address - Street 2:SUITE 1200
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-362-3970
Practice Address - Fax:845-362-3972
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF3010421363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P52031Medicare UPIN
NY2E5751Medicare ID - Type Unspecified