Provider Demographics
NPI:1275698854
Name:LEBRUN, AMY (APRN,BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LEBRUN
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N EVERBROOK LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5200
Mailing Address - Country:US
Mailing Address - Phone:765-741-1411
Mailing Address - Fax:765-741-1424
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-741-1411
Practice Address - Fax:765-741-1424
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001079A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000501656OtherBLUE CROSS BLUE SHIELD
INP39893Medicare UPIN