Provider Demographics
NPI:1477005304
Name:BRUHN, COLLEEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BRUHN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:2825 SIENA HEIGHTS DR STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3976
Practice Address - Country:US
Practice Address - Phone:702-940-1535
Practice Address - Fax:702-940-1536
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014934363LF0000X
NV817769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV817769OtherSTATE LICENSE
NV1477005304Medicaid