Provider Demographics
NPI:1629695119
Name:BRUECHERT, KIFFANY DAWN
Entity Type:Individual
Prefix:
First Name:KIFFANY
Middle Name:DAWN
Last Name:BRUECHERT
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 1:605 17TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3317
Mailing Address - Country:US
Mailing Address - Phone:701-899-2366
Mailing Address - Fax:
Practice Address - Street 1:605 17TH AVE N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3317
Practice Address - Country:US
Practice Address - Phone:701-899-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker