Provider Demographics
NPI:1023502895
Name:DUNMIRE, BRENDA (CRNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:DUNMIRE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:RUTKOSKI
Other - Last Name:DUNMIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:7058 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-8308
Mailing Address - Country:US
Mailing Address - Phone:724-448-7886
Mailing Address - Fax:724-334-7708
Practice Address - Street 1:4815 LIBERTY AVE STE 250
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224
Practice Address - Country:US
Practice Address - Phone:412-578-6815
Practice Address - Fax:412-578-4299
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018603363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid
PA14273761OtherCAQH