Provider Demographics
NPI:1659704187
Name:BRUNETTI, JAMIE MICHELE (RNMSNAPRNFNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELE
Last Name:BRUNETTI
Suffix:
Gender:F
Credentials:RNMSNAPRNFNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 FARMDALE RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1321
Mailing Address - Country:US
Mailing Address - Phone:304-529-7004
Mailing Address - Fax:304-345-4527
Practice Address - Street 1:6475 FARMDALE ROAD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-529-7004
Practice Address - Fax:304-529-7303
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV70847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026861Medicaid
WVWV3385AOtherMEDICARE