Healthcare Provider Details

I. General information

NPI: 1609019330
Provider Name (Legal Business Name): JESSICA JONES BRUINIUS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 EAST PARIS AVE SE #100 COMPREHENSIVE EAR, NOSE AND THROAT, P.C.
GRAND RAPIDS TOWNSHIP MI
49546
US

IV. Provider business mailing address

7146 DRIFTWOOD DR SE
ADA MI
49301-7890
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-0380
  • Fax:
Mailing address:
  • Phone: 616-682-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: