Provider Demographics
NPI:1942367834
Name:BRUGMAN, TERESA (APRN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BRUGMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833-2009
Mailing Address - Country:US
Mailing Address - Phone:978-979-8337
Mailing Address - Fax:978-769-5240
Practice Address - Street 1:33 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833-2009
Practice Address - Country:US
Practice Address - Phone:978-979-8337
Practice Address - Fax:978-769-5240
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN126320163WP0807X, 163WP0809X
MA126320163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABRNS0098Medicare ID - Type Unspecified