Provider Demographics
NPI:1942428792
Name:BRUCHALSKI, AMBER SUE (LPN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:SUE
Last Name:BRUCHALSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2028
Mailing Address - Country:US
Mailing Address - Phone:410-768-4291
Mailing Address - Fax:
Practice Address - Street 1:8 ROSEDALE AVE
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2028
Practice Address - Country:US
Practice Address - Phone:410-768-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP1575164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse