Provider Demographics
NPI:1588174437
Name:BRUENING, RACHEL GABRIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:GABRIELLE
Last Name:BRUENING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 401
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1438
Mailing Address - Country:US
Mailing Address - Phone:814-877-8680
Mailing Address - Fax:814-456-9613
Practice Address - Street 1:300 STATE ST STE 401
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1438
Practice Address - Country:US
Practice Address - Phone:814-877-8680
Practice Address - Fax:814-456-9613
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant