Individual
JACQLENE CHRISTINA BRUNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3555 W 13 MILE RD STE N120, ROYAL OAK, MI 48073-6710
(855) 863-8761
(248) 551-2301
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006361
MI
Other
Enumeration date
06/22/2012
Last updated
01/22/2021
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