Provider Demographics
NPI:1396439360
Name:BRUNE, JOSHUA PHILIP (PA-S)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:PHILIP
Last Name:BRUNE
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12709 GRAND STATION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-8958
Mailing Address - Country:US
Mailing Address - Phone:260-251-5674
Mailing Address - Fax:
Practice Address - Street 1:12709 GRAND STATION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-8958
Practice Address - Country:US
Practice Address - Phone:260-251-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant