Provider Demographics
NPI:1326306812
Name:BRUBAKER, MARIA GEERTRUIDA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GEERTRUIDA
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 ROMANESCA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5532
Mailing Address - Country:US
Mailing Address - Phone:702-896-4228
Mailing Address - Fax:
Practice Address - Street 1:6375 W CHARLESTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1139
Practice Address - Country:US
Practice Address - Phone:702-253-0818
Practice Address - Fax:702-253-9625
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN69948163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse