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Individual

NICOLE S BRUNETTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
600 EAST BLVD, EMERGENCY DEPARTMENT, ELKHART, IN 46514-2483
(574) 523-3161
(574) 273-1137
Mailing address
600 EAST BLVD, EMERGENCY DEPARTMENT, ELKHART, IN 46514-2483
(574) 523-3161
(574) 273-1137

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01050872
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000190010
ANTHEM
IN
05
104280367
MI
05
2003188880
IN
01
930102252
RAIL ROAD MEDICARE
IN
Enumeration date
07/29/2005
Last updated
12/20/2011
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