Provider Demographics
NPI:1508583006
Name:BRUGMANN, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRUGMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W MAPLE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2858
Mailing Address - Country:US
Mailing Address - Phone:330-442-2664
Mailing Address - Fax:330-775-7889
Practice Address - Street 1:1303 W MAPLE ST STE 102
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2858
Practice Address - Country:US
Practice Address - Phone:330-442-2664
Practice Address - Fax:330-775-7889
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032613363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
15773739OtherCAQH
OH0024844Medicaid