Provider Demographics
NPI:1982882387
Name:BRUNER, SHIRLEY A (LPN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:BRUNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8961 LAURIE LN
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:WI
Mailing Address - Zip Code:53011-1137
Mailing Address - Country:US
Mailing Address - Phone:920-528-7588
Mailing Address - Fax:
Practice Address - Street 1:W8961 LAURIE LN
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:WI
Practice Address - Zip Code:53011-1137
Practice Address - Country:US
Practice Address - Phone:920-528-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse