Provider Demographics
NPI:1952726564
Name:BRULHARDT, MARIANNE ELIZABETH (NPP)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:BRULHARDT
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 TINSEL CT
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1936
Mailing Address - Country:US
Mailing Address - Phone:631-383-3689
Mailing Address - Fax:412-753-7938
Practice Address - Street 1:58 TINSEL CT
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1936
Practice Address - Country:US
Practice Address - Phone:631-383-3689
Practice Address - Fax:412-753-7938
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401665363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health