Individual
MRS. LISA MARIE VAN BRUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
161 FORT WASHINGTON AVE, IP7, NEW YORK, NY 10032-3729
(212) 305-9770
(212) 342-5220
Mailing address
161 FORT WASHINGTON AVENUE, BUILDING IP7, NY, NY 10032
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F381121
NY
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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