Provider Demographics
NPI:1851344089
Name:BRUNTON, PATRICIA LYNN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LYNN
Last Name:BRUNTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 SANDHILL DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3733
Mailing Address - Country:US
Mailing Address - Phone:770-922-6991
Mailing Address - Fax:770-922-8260
Practice Address - Street 1:3691 SANDHILL DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3733
Practice Address - Country:US
Practice Address - Phone:770-922-6991
Practice Address - Fax:770-922-8260
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN060117367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43BBCWWMedicare PIN