Provider Demographics
NPI:1912456153
Name:BRUEN, GALE
Entity type:Individual
Prefix:
First Name:GALE
Middle Name:
Last Name:BRUEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 ORMOND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-2245
Mailing Address - Country:US
Mailing Address - Phone:248-396-8926
Mailing Address - Fax:
Practice Address - Street 1:2115 ORMOND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48383-2245
Practice Address - Country:US
Practice Address - Phone:248-396-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other