Healthcare Provider Details

I. General information

NPI: 1508834912
Provider Name (Legal Business Name): JANE E. BRUNELLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST
HOLYOKE MA
01040-5124
US

IV. Provider business mailing address

PO BOX 6260 230 MAPLE ST
HOLYOKE MA
01041-6260
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2200
  • Fax: 413-539-9472
Mailing address:
  • Phone: 413-420-2200
  • Fax: 413-539-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number160040
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: