Provider Demographics
NPI:1831647940
Name:BRUNSVOLD, ABIGAIL CARMEN (DNP,APRN, CPNP-AC/PC)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:CARMEN
Last Name:BRUNSVOLD
Suffix:
Gender:F
Credentials:DNP,APRN, CPNP-AC/PC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:CARMEN
Other - Last Name:BURKETT VETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP,APRN, CPNP-AC/PC
Mailing Address - Street 1:1420 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2744
Mailing Address - Country:US
Mailing Address - Phone:701-306-7299
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-18
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR36417363LP0200X
MNCNP 4785363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics