Provider Demographics
NPI:1750668331
Name:WILSON, AMANDA BRUNING (RN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BRUNING
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:SEAVEY
Other - Last Name:BRUNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1025 ISLAND AVE UNIT 503
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7273
Mailing Address - Country:US
Mailing Address - Phone:858-231-4132
Mailing Address - Fax:
Practice Address - Street 1:460 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3610
Practice Address - Country:US
Practice Address - Phone:858-231-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA752893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse