Basic Information
| Provider Information | |||||||||
| NPI: | 1275698854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEBRUN | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | APRN,BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3620 N EVERBROOK LN | ||||||||
| Address2: | SUITE F | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473045200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657411411 | ||||||||
| FaxNumber: | 7657411424 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 W UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473033428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657411411 | ||||||||
| FaxNumber: | 7657411424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 71001079A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 000000501656 | 01 | IN | BLUE CROSS BLUE SHIELD | OTHER |