Provider Demographics
NPI:1376849737
Name:BRUNER, SUSAN KS (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KS
Last Name:BRUNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 E SPRINGFIELD AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2913
Mailing Address - Country:US
Mailing Address - Phone:509-262-6406
Mailing Address - Fax:
Practice Address - Street 1:1817 E SPRINGFIELD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2913
Practice Address - Country:US
Practice Address - Phone:509-262-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00151042163WP0808X, 163WP0809X
WAAP60211296363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8900962OtherMEDICARE PTAN