Provider Demographics
NPI:1114734787
Name:BRUNER, JENNIFER NEAL (HIS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NEAL
Last Name:BRUNER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 NEUSE BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4318
Mailing Address - Country:US
Mailing Address - Phone:252-635-5005
Mailing Address - Fax:
Practice Address - Street 1:2111 NEUSE BLVD STE I
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4318
Practice Address - Country:US
Practice Address - Phone:252-635-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1689237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist