Provider Demographics
NPI:1497387294
Name:BRUNER, TRALA RENAE
Entity Type:Individual
Prefix:
First Name:TRALA
Middle Name:RENAE
Last Name:BRUNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E MIDLOTHIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1945
Mailing Address - Country:US
Mailing Address - Phone:234-228-3847
Mailing Address - Fax:
Practice Address - Street 1:190 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1945
Practice Address - Country:US
Practice Address - Phone:234-228-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide