Provider Demographics
NPI:1609802453
Name:BRUNFELT, JESSICA LEE TOMLIN (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE TOMLIN
Last Name:BRUNFELT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8013
Mailing Address - Country:US
Mailing Address - Phone:651-982-7600
Mailing Address - Fax:
Practice Address - Street 1:5200 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8013
Practice Address - Country:US
Practice Address - Phone:651-982-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 147155-7363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4304547Medicaid
MN2293216OtherARAZ
MN01-06279OtherMEDICA PRIMARY
MN132544OtherUCARE
MNHP48876OtherHEALTHPARTNERS
MN01-19710OtherMEDICA CHOICE
MN1042813OtherPREFERRED ONE
MN459R7TOOtherBCBS
IA0590695OtherIA MA
MN403132600Medicaid
WI41254200Medicaid
MN459R7TOOtherBCBS