Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Khadijah Desiree Brunner

Individual provider Other Technician · NPI 1174282743

Mrs. Khadijah Desiree Brunner is an Other Technician in White Bear Lake, Minnesota. Licensed in Minnesota. Registered with an NPI since 2021.

Licensed in
MN
In the registry since
2021

Practice location Address checks out

1011 Meadowlands Dr
White Bear Lake, MN 55127-2339
Phone: (612) 315-1976
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Other Technician (primary) Taxonomy 247200000X (MN)

Record details

NPI number1174282743
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 10, 2021
Last updated in NPPESDecember 12, 2021
Certification dateDecember 12, 2021

Other providers in White Bear Lake