Provider Demographics
NPI:1821545799
Name:BRUESTLE, EVA LIANA (MT)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:LIANA
Last Name:BRUESTLE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MISS
Other - First Name:EVA
Other - Middle Name:LIANA
Other - Last Name:ARCHAMBAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:4590 SCOTT TRL STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4041
Mailing Address - Country:US
Mailing Address - Phone:651-454-1000
Mailing Address - Fax:
Practice Address - Street 1:4590 SCOTT TRL STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4041
Practice Address - Country:US
Practice Address - Phone:651-454-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist