Provider Demographics
NPI:1063053809
Name:BUKOSKI, BREANNA VICTORIA (PA-C)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:VICTORIA
Last Name:BUKOSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:VICTORIA
Other - Last Name:SCHNUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:505 N CLIPPERT ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 N CLIPPERT ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4701
Practice Address - Country:US
Practice Address - Phone:517-999-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant