Healthcare Provider Details

I. General information

NPI: 1831266501
Provider Name (Legal Business Name): SELINA MARIE BRUGLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BEAM AVE
MAPLEWOOD MN
55109-1126
US

IV. Provider business mailing address

5925 DAVID CT
SHOREVIEW MN
55126-4664
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7000
  • Fax:
Mailing address:
  • Phone: 651-308-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP0530
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: