Individual
ANDREA JAYNE BRUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7333 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6202
(260) 458-3825
Mailing address
9820 BANYAN CT, FORT WAYNE, IN 46835-9441
(260) 402-6726
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003380A
IN
Other
Enumeration date
10/04/2021
Last updated
10/21/2021
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