MEDICARE: MRS. JENNIFER SUZANNE BRUNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1700921079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER SUZANNE BRUNS

Provider Business Mailing Address
First Line	:	1300 DELAWARE ST APT 42
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1472
Country	:	US
Telephone Number	:	510-981-0525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 ARNOLD DR STE 160
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-6537
Country	:	US
Telephone Number	:	925-229-5400
Fax Number	:	925-229-5406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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