Provider Demographics
NPI:1982712048
Name:BRUBAKER, CHERYL RENEE (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:RENEE
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 CARDENAS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2540
Mailing Address - Country:US
Mailing Address - Phone:505-280-6246
Mailing Address - Fax:
Practice Address - Street 1:3217 CARDENAS DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2540
Practice Address - Country:US
Practice Address - Phone:505-280-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00258363LF0000X
NMR18198163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46830383Medicaid
NMNM006A84OtherBCBS OF NM
Q49406Medicare UPIN
NM46830383Medicaid