Healthcare Provider Details

I. General information

NPI: 1225574973
Provider Name (Legal Business Name): ELIZABETH S BRUGGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH S GREEN

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 W. BADURA AVE FL 2 STE F
LAS VEGAS NV
89113
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-435-5437
  • Fax: 702-851-9640
Mailing address:
  • Phone: 702-216-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN002434
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: