Provider Demographics
NPI:1710434055
Name:BRUNSON, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BRUNSON
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 1:7380 W SAHARA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2762
Mailing Address - Country:US
Mailing Address - Phone:725-333-2411
Mailing Address - Fax:702-952-5257
Practice Address - Street 1:7380 W SAHARA AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:725-333-2411
Practice Address - Fax:702-952-5257
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018026578363LP0808X
OR201801732NPPP363LP0808X
WAAP60838569363LP0808X
NV825045363LP0808X
MN5803363LP0808X
WI8279-33363LP0808X
TXAP132667363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health