Individual
JESSICA SOPHIA BRONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1225 E COOLSPRING AVE STE 2B, MICHIGAN CITY, IN 46360-6312
(219) 878-5029
(219) 878-8493
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28142364A
IN
363LF0000X
Family Nurse Practitioner
71003880A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201068100
—
IN
Enumeration date
01/02/2012
Last updated
04/14/2023
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