Provider Demographics
NPI:1700019726
Name:BROWN BRUGO, ROBERTA LOUISE (RN, LMT,HTCP)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:LOUISE
Last Name:BROWN BRUGO
Suffix:
Gender:F
Credentials:RN, LMT,HTCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PERRYRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4608
Mailing Address - Country:US
Mailing Address - Phone:203-863-3615
Mailing Address - Fax:
Practice Address - Street 1:5 PERRYRIDGE ROAD
Practice Address - Street 2:GREENWICH HOSPITAL
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-863-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE39549163W00000X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)