Bruessow, Diane M
Bruessow, Diane M is an sole proprietor health care provider with primary practice located at 123 Main St Unit 60538 , Florence MA 01062-7026. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Bruessow, Diane M can be contacted via phone (718) 894-0301.Contact Information
Primary practice address
123 Main St Unit 60538
Florence MA 01062-7026
Phone: (718) 894-0301
Fax: (718) 894-0301
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 004819-1 | New York |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 25MP00141700 | New Jersey |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA1010 | Wyoming |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA8022 | Massachusetts |
Profile Details
| NPI number | 1063552487 |
|---|---|
| LBN Legal business name | Bruessow, Diane M |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 7th, 2007 |
| Last updated | Apr 8th, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063552487 | NPPES |
| Connecticut | Other | 6421 | LICENSE |
| Connecticut | Other | 004819 | LICENSE |
| Connecticut | Other | PA1010 | LICENSE |
| Connecticut | Other | PA8820 | LICENSE |
| Connecticut | Other | 25MP00141700 | LICENSE |
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