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Individual
NICOLE M. BRUNELLE
Active
Individual
NICOLE M. BRUNELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, ANP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
741023
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197288701
—
TX
01
—
8Y8757
BCBS
TX
01
—
P00729492
RR MEDICARE
TX
Enumeration date
10/09/2007
Last updated
03/30/2011
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