Provider Demographics
NPI:1093709800
Name:BRUNNER, DARLENE RUTH (WOMEN'S HEALTH NP)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:RUTH
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:WOMEN'S HEALTH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W LOSEY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225-5250
Mailing Address - Country:US
Mailing Address - Phone:618-256-7600
Mailing Address - Fax:618-256-7619
Practice Address - Street 1:310 W LOSEY ST
Practice Address - Street 2:
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5250
Practice Address - Country:US
Practice Address - Phone:618-256-7600
Practice Address - Fax:618-256-7619
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-233266363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health