Individual
YVONNE L BRUNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4307 71ST ST N, ST PETERSBURG, FL 33709-4513
(312) 953-9787
Mailing address
4307 71ST ST N, ST PETERSBURG, FL 33709-4513
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
9111861
FL
208VP0014X
Interventional Pain Medicine Physician
Primary
9111861
FL
Other
Enumeration date
01/16/2019
Last updated
10/18/2019
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