Provider Demographics
NPI:1831156520
Name:BRUNDIGE, KARYN JEAN (RN, APRN)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:JEAN
Last Name:BRUNDIGE
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:CANCER AND BLOOD DISORDERS CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-8246
Mailing Address - Fax:617-730-0641
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:CANCER AND BLOOD DISORDERS CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-8246
Practice Address - Fax:617-730-0641
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004610363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9627712Medicaid
WAP29548Medicare UPIN
WAAB37995Medicare ID - Type Unspecified