Provider Demographics
NPI:1821014051
Name:BRUNSTROM-HERNANDEZ, JANICE ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:ELAINE
Last Name:BRUNSTROM-HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251665
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-1515
Mailing Address - Country:US
Mailing Address - Phone:469-331-0030
Mailing Address - Fax:469-331-0031
Practice Address - Street 1:7709 SAN JACINTO PL STE 203
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3368
Practice Address - Country:US
Practice Address - Phone:469-331-0030
Practice Address - Fax:469-331-0031
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1011822084N0402X
TXM50742084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO069010101Medicaid
TX339120301Medicaid
TX339120303Medicaid
TX339120302Medicaid
MO130011698Medicare PIN