Provider Demographics
NPI:1245357573
Name:BRUEN, MARY JANE (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:BRUEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:ORDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6208
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5490
Practice Address - Fax:517-364-5499
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704110413363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4327027Medicaid
MI5008765830OtherBCBS INDIVIDUAL PIN
MI5008765830OtherBCBS INDIVIDUAL PIN
MI4327027Medicaid