Provider Demographics
NPI:1184859126
Name:BRUNETT-WOLPERT, PATRICIA J (ACNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:BRUNETT-WOLPERT
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:BRUNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2684
Mailing Address - Country:US
Mailing Address - Phone:937-208-8885
Mailing Address - Fax:937-208-8895
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-208-8885
Practice Address - Fax:937-208-8895
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10677-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2962012Medicaid
OHNP31171Medicare PIN
OHH107380Medicare PIN