Provider Demographics
NPI:1649294828
Name:BRUEGGEMANN, CARL JR (CRNA)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:BRUEGGEMANN
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8718 SIGNAL POINTE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8405
Mailing Address - Country:US
Mailing Address - Phone:859-371-6419
Mailing Address - Fax:
Practice Address - Street 1:8718 SIGNAL POINTE CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8405
Practice Address - Country:US
Practice Address - Phone:859-371-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001240367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered