Provider Demographics
NPI:1992857486
Name:BRULE, NICOLE BOSUSTOW (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:BOSUSTOW
Last Name:BRULE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 11TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3370
Mailing Address - Country:US
Mailing Address - Phone:541-953-3929
Mailing Address - Fax:
Practice Address - Street 1:220 E 11TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3370
Practice Address - Country:US
Practice Address - Phone:541-953-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1832103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist