Healthcare Provider Details

I. General information

NPI: 1699741355
Provider Name (Legal Business Name): JANE ELIZABETH BRUEGGEMANN ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11953 W LOCUST LN
COLUMBUS IN
47201-2756
US

IV. Provider business mailing address

11953 W LOCUST LN
COLUMBUS IN
47201-2756
US

V. Phone/Fax

Practice location:
  • Phone: 812-343-1050
  • Fax: 812-512-1241
Mailing address:
  • Phone: 812-342-6198
  • Fax: 812-342-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71001864A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: