Individual
MARY JANE BRUEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1200 E MICHIGAN AVE, SUITE 460, LANSING, MI 48912-1800
(517) 364-5490
(517) 364-5499
Mailing address
PO BOX 13008, LANSING, MI 48901-3008
(517) 364-6253
(517) 364-6208
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704110413
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4327027
—
MI
01
—
5008765830
BCBS INDIVIDUAL PIN
MI
Enumeration date
03/23/2007
Last updated
07/08/2007
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