Provider Demographics
NPI:1306406434
Name:BRUNN, JENNA ALYS (MD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ALYS
Last Name:BRUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ALYS
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3838 MASSILLON RD STE 360
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7965
Mailing Address - Country:US
Mailing Address - Phone:330-896-9625
Mailing Address - Fax:330-896-9768
Practice Address - Street 1:3838 MASSILLON RD STE 360
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7965
Practice Address - Country:US
Practice Address - Phone:330-896-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1517812084N0400X
MI43015088582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology