Provider Demographics
NPI:1750722476
Name:BRUGEL, NINA LAURY (LAC)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:LAURY
Last Name:BRUGEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CHURCH ST NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4708
Mailing Address - Country:US
Mailing Address - Phone:703-407-4234
Mailing Address - Fax:
Practice Address - Street 1:421 CHURCH ST NE
Practice Address - Street 2:SUITE E
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4708
Practice Address - Country:US
Practice Address - Phone:703-407-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000702171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist