Doctor Name: | BRUNA M. GRIENEISEN |
NPI Number: | 1417964743 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | MA-052124 |
Business Practice Address: | 1200 Wood St Brockway, PA - 158242118 |
Business Phone Number: | 8142658636 |
Business Fax Number: | 8142658536 |
Mailing Address: | Po Box 447, DU BOIS |
State: | PA |
Postal Code: | 158010447 |
Phone Number: | 8142658636 |
Fax Number: | 8142658536 |
NPI Enumeration Date: | 08/01/2006 |
NPI Last Update Date: | 06/17/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA-052124 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |