Healthcare Provider Details

I. General information

NPI: 1528971199
Provider Name (Legal Business Name): BETHANY BRUEGGEN BSN, SANE-A, SANE-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5400 NANAINA PL
HOLUALOA HI
96725-9645
US

IV. Provider business mailing address

PO BOX 142
HOLUALOA HI
96725-0142
US

V. Phone/Fax

Practice location:
  • Phone: 720-402-9819
  • Fax:
Mailing address:
  • Phone: 720-402-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number116979
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: