Provider Demographics
NPI:1003317124
Name:HORNER, MICHELE BRUNO (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:BRUNO
Last Name:HORNER
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ANNE
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-6659
Mailing Address - Fax:732-249-2687
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-6659
Practice Address - Fax:732-249-2687
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MJ00007200170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS