Provider Demographics
NPI:1154413896
Name:BRUNNER, STEPHANIE A (NPF)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:NPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 S SYRACUSE WAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4707
Mailing Address - Country:US
Mailing Address - Phone:303-220-5707
Mailing Address - Fax:
Practice Address - Street 1:6161 S SYRACUSE WAY
Practice Address - Street 2:SUITE 310
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4707
Practice Address - Country:US
Practice Address - Phone:303-220-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO113912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42578876Medicaid
CO343858Medicare ID - Type Unspecified