Provider Demographics
NPI:1932701950
Name:BRUGGEMAN, KIMBERLIE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLIE
Middle Name:
Last Name:BRUGGEMAN
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 1:110 S RIVERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1140
Mailing Address - Country:US
Mailing Address - Phone:614-638-6872
Mailing Address - Fax:
Practice Address - Street 1:110 S RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1140
Practice Address - Country:US
Practice Address - Phone:614-638-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant