Provider Demographics
NPI:1740828615
Name:BRUNN, ANNA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BRUNN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SAN MARIN DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1100
Mailing Address - Country:US
Mailing Address - Phone:415-899-7412
Mailing Address - Fax:707-542-9958
Practice Address - Street 1:2323 BETHARDS DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8500
Practice Address - Country:US
Practice Address - Phone:707-542-1611
Practice Address - Fax:707-542-9958
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily