Individual provider · NPI-1

Jennifer Rose Bruckstein, PA-C

Physician Assistant · Wilson, NC

NPI number1114695699
StatusActive
Last updated in NPPESAug 31, 2021

Details

NPI
1114695699
Entity type
Individual (NPI-1)
Name
Miss Jennifer Rose Bruckstein
Credential
PA-C
Sex
Female
Sole proprietor
No
Enumeration date
Aug 31, 2021
Certification date
Jul 15, 2021
Last updated
Aug 31, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant0010-11413NCYes

Practice location

2231 Nash Street North Suite A
Wilson, NC 27896

Phone 252-281-2515

Mailing address

605 Cassell Dr Apt 303
Fayetteville, NC 28311-1663

Phone 908-577-2576

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