Provider Demographics
NPI:1558414771
Name:BRUNIGES, VIVIENNE JANE (FNP)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:JANE
Last Name:BRUNIGES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-384-5766
Mailing Address - Fax:209-383-4230
Practice Address - Street 1:374 E OLIVE AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-384-5766
Practice Address - Fax:209-383-4230
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14829363A00000X
CANP10452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner