Provider Demographics
NPI:1558942284
Name:BRUN, MERRY M (RN)
Entity Type:Individual
Prefix:
First Name:MERRY
Middle Name:M
Last Name:BRUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 MAIN ST STE 4-155
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3506
Mailing Address - Country:US
Mailing Address - Phone:862-220-1290
Mailing Address - Fax:
Practice Address - Street 1:982 MAIN ST STE 4-155
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3506
Practice Address - Country:US
Practice Address - Phone:862-220-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718615163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management