Active NPI
Jenna Marie Brunger
- Registered Dietitian
- Mesa, AZ
National Provider Identifier
1760090179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86116407
- Practice address
- 6124 E Brown Rd Ste 102
Mesa, AZ 85205-4959 - Phone
- (480) 809-6513
- NPI assigned
- Jul 22, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86116407 | MI | Primary |
Addresses
Primary practice location
6124 E Brown Rd Ste 102
Mesa, AZ 85205-4959
Mailing address
7340 E Legacy Blvd Unit H2009
Scottsdale, AZ 85255-6529
Phone (616) 298-6835
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86116407 | MI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595376000000",
"number": "1760090179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7340 E LEGACY BLVD UNIT H2009",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852556529",
"telephone_number": "616-298-6835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6124 E BROWN RD STE 102",
"city": "MESA",
"state": "AZ",
"postal_code": "852054959",
"telephone_number": "480-809-6513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNGER",
"first_name": "JENNA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-22",
"last_updated": "2020-07-22",
"certification_date": "2020-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "86116407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.