Provider Demographics
NPI:1801371067
Name:BRUNELLE, ZSAZSA VANESSA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ZSAZSA
Middle Name:VANESSA
Last Name:BRUNELLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ZSAZSA
Other - Middle Name:VANESSA
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:16 FLAGG HL
Mailing Address - Street 2:
Mailing Address - City:ERVING
Mailing Address - State:MA
Mailing Address - Zip Code:01344
Mailing Address - Country:US
Mailing Address - Phone:413-329-9121
Mailing Address - Fax:
Practice Address - Street 1:16 FLAGG HL
Practice Address - Street 2:
Practice Address - City:ERVING
Practice Address - State:MA
Practice Address - Zip Code:01344
Practice Address - Country:US
Practice Address - Phone:413-329-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN86407164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse