Provider Demographics
NPI:1699097659
Name:BRUNNER, DAVID (CRNA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BRUNNER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-2402
Mailing Address - Country:US
Mailing Address - Phone:660-359-5621
Mailing Address - Fax:660-359-3541
Practice Address - Street 1:701 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2402
Practice Address - Country:US
Practice Address - Phone:660-359-5621
Practice Address - Fax:660-359-3541
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO088488367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered