Provider Demographics
NPI:1083886410
Name:BRUCKNER, JUDITH M (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:M
Last Name:BRUCKNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19538 DAYTON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-8831
Mailing Address - Country:US
Mailing Address - Phone:920-598-0198
Mailing Address - Fax:
Practice Address - Street 1:19538 DAYTON RIDGE RD
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-8831
Practice Address - Country:US
Practice Address - Phone:920-598-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58585030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse