Provider Demographics
NPI:1235162686
Name:BRUNK, TAMMY MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:BRUNK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MARIE
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8223 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3036
Mailing Address - Country:US
Mailing Address - Phone:970-353-6000
Mailing Address - Fax:970-353-6001
Practice Address - Street 1:8223 W 20TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3036
Practice Address - Country:US
Practice Address - Phone:970-353-6000
Practice Address - Fax:970-353-6001
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO114327367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43902723Medicaid
CO458248Medicare ID - Type Unspecified
CO43902723Medicaid