Individual
CONNIE MARIE BRUNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7777 HENNESSY BLVD STE 501B, BATON ROUGE, LA 70808-4300
(225) 765-3456
(225) 765-1899
Mailing address
7777 HENNESSY BLVD, SUITE 406, BATON ROUGE, LA 70808-4300
(225) 765-3456
(225) 765-1899
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.200104.RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08623701
—
MS
05
—
1455261
—
LA
Enumeration date
09/27/2006
Last updated
01/26/2021
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