Individual
MR. MATTHEW W. BRUNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
12349 DE PAUL DR STE 100, BRIDGETON, MO 63044-2512
(314) 291-7900
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-4038
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2018022966
MO
363L00000X
Nurse Practitioner
209006084
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209006084
ILLINOIS LICENSE NUMBER
IL
Enumeration date
07/31/2006
Last updated
10/20/2020
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