Provider Demographics
NPI:1871145623
Name:BRUNETTI, ANTHONY PAUL (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PAUL
Last Name:BRUNETTI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6729
Mailing Address - Country:US
Mailing Address - Phone:304-253-1077
Mailing Address - Fax:304-253-9611
Practice Address - Street 1:215 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6729
Practice Address - Country:US
Practice Address - Phone:304-253-1077
Practice Address - Fax:304-253-9611
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2882363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical