Provider Demographics
NPI:1407939200
Name:BRUNK, LAURIE (CPNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BRUNK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PENNS WAY
Mailing Address - Street 2:SUITE 412
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720
Mailing Address - Country:US
Mailing Address - Phone:302-652-2455
Mailing Address - Fax:302-322-6251
Practice Address - Street 1:1802 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-652-2455
Practice Address - Fax:302-322-6251
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELJ-0000153363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics