Provider Demographics
NPI:1144806480
Name:BRUNDAGE, JULIE RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:RENEE
Last Name:BRUNDAGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 MARBLETOWN RD APT C
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-9018
Mailing Address - Country:US
Mailing Address - Phone:315-521-0360
Mailing Address - Fax:
Practice Address - Street 1:184 MARBLETOWN RD APT C
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-9018
Practice Address - Country:US
Practice Address - Phone:315-521-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316425-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse