Provider Demographics
NPI:1609053602
Name:BRUHL, KIMBERLY ANNETTE (RN, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNETTE
Last Name:BRUHL
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-824-1952
Mailing Address - Fax:419-824-0344
Practice Address - Street 1:5308 HARROUN RD
Practice Address - Street 2:SUITE 055
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2114
Practice Address - Country:US
Practice Address - Phone:419-824-6599
Practice Address - Fax:419-885-3870
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 09796363L00000X
MI4704263022363L00000X
OHAPRN.09796207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBRNP26021OtherMEDICARE PTAN
OHH388051OtherMEDICARE PTAN
OH2831912Medicaid
MIN64970005OtherMEDICARE PTAN
OHPOO904169OtherRRMC