Provider Demographics
NPI:1235203274
Name:BRUNER-WELCH, ANN S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:S
Last Name:BRUNER-WELCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-0134
Mailing Address - Country:US
Mailing Address - Phone:707-571-3079
Mailing Address - Fax:707-571-4559
Practice Address - Street 1:401 BICENTENNIAL WAY # 120
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-571-3079
Practice Address - Fax:707-571-4559
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant