Healthcare Provider Details

I. General information

NPI: 1215035423
Provider Name (Legal Business Name): JENNIFER LYNN BRUJITSKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24430 FORD RD STE A
DEARBORN HEIGHTS MI
48127-3280
US

IV. Provider business mailing address

PO BOX 670660
DETROIT MI
48267-0660
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-6782
  • Fax: 313-565-6784
Mailing address:
  • Phone: 866-321-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704207537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: