Provider Demographics
NPI:1801266978
Name:BRUNTZEL, KARLA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:BRUNTZEL
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 1:604 W HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2423
Mailing Address - Country:US
Mailing Address - Phone:660-815-1315
Mailing Address - Fax:
Practice Address - Street 1:500 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3109
Practice Address - Country:US
Practice Address - Phone:660-886-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000171998174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator