Provider Demographics
NPI:1336684372
Name:BRUNMAIER, ASHLEY (CNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRUNMAIER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8451 WINCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SD
Mailing Address - Zip Code:57769-7127
Mailing Address - Country:US
Mailing Address - Phone:605-545-4800
Mailing Address - Fax:
Practice Address - Street 1:8451 WINCHESTER CT
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SD
Practice Address - Zip Code:57769-7127
Practice Address - Country:US
Practice Address - Phone:605-545-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily