Provider Demographics
NPI:1871003145
Name:BRUNS, CHELSEA E (PA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:E
Last Name:BRUNS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:E
Other - Last Name:DULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:555 W WACKERLY ST STE 1600
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2745
Mailing Address - Country:US
Mailing Address - Phone:989-631-9515
Mailing Address - Fax:989-839-8817
Practice Address - Street 1:555 W WACKERLY ST STE 1600
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-631-9515
Practice Address - Fax:989-839-8817
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881869774Medicaid