Provider Demographics
NPI:1053946335
Name:BRUNELLE, GEORGIA (MSN, FNP-C, RN)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:BRUNELLE
Suffix:
Gender:F
Credentials:MSN, FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PIKE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03872-7310
Mailing Address - Country:US
Mailing Address - Phone:603-986-2273
Mailing Address - Fax:
Practice Address - Street 1:23 PIKE BROOK RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:NH
Practice Address - Zip Code:03872-7310
Practice Address - Country:US
Practice Address - Phone:603-986-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053407-21163W00000X
NH053407-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse