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Individual

MRS. JENNIFER E BRUYERE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BA, AAS, RT(R)(M)

Contact information

Practice address
4235 32ND AVE S, MINNEAPOLIS, MN 55406-3315
(612) 729-2205
Mailing address
4235 32ND AVE S, MINNEAPOLIS, MN 55406-3315
(612) 729-2205

Taxonomy

Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
373912
MN
2471M2300X
Mammography Radiologic Technologist
373912
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
373912
AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS
MN
01
500506806
IEMA DIVISION OF NUCLEAR SAFETY
IL
Enumeration date
11/26/2012
Last updated
11/26/2012
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