Provider Demographics
NPI:1063805257
Name:BRUNNER, ALLISA (NP)
Entity type:Individual
Prefix:MRS
First Name:ALLISA
Middle Name:
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DANA DRIVE
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-2828
Mailing Address - Country:US
Mailing Address - Phone:207-698-6700
Mailing Address - Fax:
Practice Address - Street 1:4 DANA DRIVE
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03901-2828
Practice Address - Country:US
Practice Address - Phone:207-698-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151009363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner