Basic Information
Provider Information
NPI: 1194292979
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRUNS
FirstName: LINDSEY
MiddleName: KAY
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1919 EAGLE AVE
Address2:  
City: ALEXANDER
State: IA
PostalCode: 504208052
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 411 LAUREL ST
Address2:  
City: DES MOINES
State: IA
PostalCode: 503143017
CountryCode: US
TelephoneNumber: 5152830463
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/30/2018
LastUpdateDate: 12/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XD137130IAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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