Individual
NICKOLAUS BRUNKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2021 MATHER WAY APT B, ELKINS PARK, PA 19027-1032
(208) 720-6809
Mailing address
2863 N MOUNTAIN RD, BOISE, ID 83702-0650
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-759
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
10/16/2018
Last updated
10/21/2020
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