Provider Demographics
NPI:1679699987
Name:GRUNZA, BRENDA LEE (BSN, RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:GRUNZA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PUBLIC SQ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1702
Mailing Address - Country:US
Mailing Address - Phone:570-826-1777
Mailing Address - Fax:570-823-3040
Practice Address - Street 1:15 PUBLIC SQ
Practice Address - Street 2:SUITE 600
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1702
Practice Address - Country:US
Practice Address - Phone:570-826-1777
Practice Address - Fax:570-823-3040
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN289124L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007678420038Medicaid
PA1016105620003Medicaid
PA1016105620002Medicaid