Provider Demographics
NPI:1487217410
Name:BRUNSON, MRS.MONIQUE (CERTIFIED NURSE AID)
Entity Type:Individual
Prefix:PROF
First Name:MRS.MONIQUE
Middle Name:
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:CERTIFIED NURSE AID
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:BRUNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MONA BRUNSON
Mailing Address - Street 1:10042 EMERALD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-6404
Mailing Address - Country:US
Mailing Address - Phone:901-290-2048
Mailing Address - Fax:662-590-0934
Practice Address - Street 1:10042 EMERALD FOREST DR
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-6404
Practice Address - Country:US
Practice Address - Phone:662-368-2575
Practice Address - Fax:662-590-0934
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 3747A0650X, 376J00000X, 3747P1801X
TN374T00000X
MS374T00000X
MS10085872374U00000X
TN102382376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide