Provider Demographics
NPI:1770368532
Name:BRUNELLE, MONIQUE MARIE (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE
Last Name:BRUNELLE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043-7479
Mailing Address - Country:US
Mailing Address - Phone:860-646-0649
Mailing Address - Fax:860-512-0380
Practice Address - Street 1:921 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:CT
Practice Address - Zip Code:06043-7479
Practice Address - Country:US
Practice Address - Phone:860-646-0649
Practice Address - Fax:860-512-0380
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily