Healthcare Provider Details

I. General information

NPI: 1942367834
Provider Name (Legal Business Name): TERESA BRUGMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W MAIN ST
GEORGETOWN MA
01833-2009
US

IV. Provider business mailing address

33 W MAIN ST
GEORGETOWN MA
01833-2009
US

V. Phone/Fax

Practice location:
  • Phone: 978-979-8337
  • Fax: 978-769-5240
Mailing address:
  • Phone: 978-979-8337
  • Fax: 978-769-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN126320
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN126320
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number126320
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: