Provider Demographics
NPI:1972214476
Name:BRUNETTE, CLARA R
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:R
Last Name:BRUNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 IRON BRIDGE RD STE 201B
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6459
Mailing Address - Country:US
Mailing Address - Phone:804-621-4236
Mailing Address - Fax:
Practice Address - Street 1:9620 IRON BRIDGE RD STE 201B
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6459
Practice Address - Country:US
Practice Address - Phone:804-621-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker