Provider Demographics
NPI:1114402021
Name:BRUNK, DEBRA (CNS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:BRUNK
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3738 E WELDON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5816
Mailing Address - Country:US
Mailing Address - Phone:480-442-0191
Mailing Address - Fax:
Practice Address - Street 1:1428 E NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4319
Practice Address - Country:US
Practice Address - Phone:480-442-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist