Individual
JEAN BRUDENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3111 EDGEROCK DR, EL PASO, TX 79935-1524
(915) 540-0805
Mailing address
700 WOODLAND AVE, EL PASO, TX 79922-2040
(915) 540-0805
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
171240555
FL
253J00000X
Foster Care Agency
171240555
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171240555
NURSING ADMINISTRATOR
FL
Enumeration date
05/25/2022
Last updated
05/25/2022
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