Provider Demographics
NPI:1235560285
Name:BRUNNER, GRACE (APN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:ELIZABETH
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:59 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1382
Mailing Address - Country:US
Mailing Address - Phone:908-451-5933
Mailing Address - Fax:
Practice Address - Street 1:59 BUNKER HILL RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1382
Practice Address - Country:US
Practice Address - Phone:908-451-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00476300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health