Doctor Name: | MICHAEL JOHN BRUNELL |
NPI Number: | 1407154552 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PENDING |
Business Practice Address: | 36 Bridge Way Pascoag, RI - 028593131 |
Business Phone Number: | 4015687661 |
Business Fax Number: | 4015670900 |
Mailing Address: | 36 Bridge Way, PASCOAG |
State: | RI |
Postal Code: | 028593131 |
Phone Number: | 4015687661 |
Fax Number: | 4015670900 |
NPI Enumeration Date: | 03/14/2011 |
NPI Last Update Date: | 03/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PENDING |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |