Provider Demographics
NPI:1316179112
Name:BRUNS, MARY M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:BRUNS
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 1:1028 GRAND CONCOURSE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8828
Mailing Address - Country:US
Mailing Address - Phone:843-795-9294
Mailing Address - Fax:
Practice Address - Street 1:1028 GRAND CONCOURSE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-8828
Practice Address - Country:US
Practice Address - Phone:843-795-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP26670164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse