HALEY MARIE BRUNKE (NPI# 1063054039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063054039 |
| Entity Type | Individual |
| Full Name | HALEY MARIE BRUNKE |
| Credential | PA-C |
| Practice Address |
161 Main St Mission SD 57555 |
| Mailing Address |
26444 285th Ave Wood SD 57585-8513 |
| Practice Telephone | 6058562295 |
| Mailing Telephone | 6054640633 |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2019-10-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
1221 | SD | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | SOUTH DAKOTA BOARD OF MEDICAL AND OSTEOPATHIC EXAMINERS | 1221 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 309 E 4th St, White River, SD 57579 | 6052593121 |
| Street Address |
161 MAIN ST |
| City | MISSION |
| State | SD |
| Zip Code | 57555 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932706892 | Kristine Ellece Smith | Social Worker | 101 Antelope Lake Circle, Mission, SD 57555 | 2020-10-05 |
| 1891352134 | Sinte Gleska University | Counselor | Antelope Lake Drive, Mission, SD 57555 | 2019-05-22 |
| 1790259182 | Charlotte Rose Emery | Counselor | 101 Antelpe Lake, Mission, SD 57555 | 2019-01-18 |
| 1285110486 | Ryan Ross Rowe | Nurse Practitioner | 161 S. Main, Mission, SD 57555 | 2018-07-11 |
| 1225578198 | Autumn Rae Tucker | Nurse Practitioner | 161 S, Main Street, Mission, SD 57555 | 2017-02-27 |
| 1497204937 | Molly Driel Dent | Psychologist | 102 E. Denver Drive, Mission, SD 57555 | 2016-09-26 |
| 1285923011 | Ed Parsells | Counselor | 250 S. Harrison St., Mission, SD 57555 | 2011-04-01 |
| 1023340767 | Burke Community Pharmacy Inc. | Pharmacy | 161 S. Main Street, Mission, SD 57555 | 2010-02-05 |
| 1366687428 | Todd County School District 66-1 | Local Education Agency (LEA) | 110 E. Denver Drive, Mission, SD 57555 | 2008-12-03 |
| 1790972719 | Angela Blane Chambers | Physician Assistant | 161 S Main St., Mission, SD 57555 | 2007-10-03 |
| Find all providers in zip 57555 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790972719 | Angela Blane Chambers | Physician Assistant | 161 S Main St., Mission, SD 57555 | 2007-10-03 |
| 1942299169 | Betty Anne Kalblinger I | Physician Assistant | 153 South Main St., Mission, SD 57555-0049 | 2005-10-20 |
| 1710976212 | Daniel Kerby Heyduk | Physician Assistant | 153 S Main, Mission, SD 57555 | 2005-10-18 |
| 1083102768 | Jose Angel Martinez Jr. | Physician Assistant | 1920 E Griffin Pkwy, Mission, TX 78572-3106 | 2018-04-27 |
| 1639627805 | Premier Mediclinic Pa | Physician Assistant | 4101 S Shary Rd, Ste 101-a, Mission, TX 78572 | 2016-09-16 |
| 1952796856 | Domiciano Espinosa | Physician Assistant | 900 S Bryan Rd, Mission, TX 78572-6613 | 2015-03-30 |
| 1902294572 | Joshua Lucas | Physician Assistant | 1920 E Griffin Pkwy, Mission, TX 78572-3106 | 2015-01-05 |
| 1003214859 | Johnson & Havener Medical Services, Pa | Physician Assistant | 1920 E Griffin Pkwy, Mission, TX 78572-3106 | 2014-12-10 |
| 1356696421 | Michelle Lynn Udelhoven | Physician Assistant | 161 S Main St, Mission, SD 57555-0049 | 2012-07-16 |
| 1760718811 | Karina Lynn Trevino | Physician Assistant | 1300 S Bryan Rd Ste 100, Mission, TX 78572-6688 | 2009-10-26 |
| Find all providers in MISSION | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.