Provider Demographics
NPI:1457671091
Name:BRUGGER, VIRGINIA BERTHA-ANNE (CNP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:BERTHA-ANNE
Last Name:BRUGGER
Suffix:
Gender:F
Credentials:CNP
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1205 BROADWAY
Mailing Address - Street 2:LORAIN COUNTY HEALTH & DENTISTRY
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3409
Mailing Address - Country:US
Mailing Address - Phone:440-240-1655
Mailing Address - Fax:440-233-0194
Practice Address - Street 1:3745 GROVE AVE.
Practice Address - Street 2:LORAIN COUNTY HEALTH & DENTISTRY
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055
Practice Address - Country:US
Practice Address - Phone:440-240-1655
Practice Address - Fax:440-233-0194
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2013-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH11454-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3072008Medicaid