Healthcare Provider Details

I. General information

NPI: 1609860493
Provider Name (Legal Business Name): LORI J. BRUEHLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI J. LINE RN, FNP

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 ROGERS RUN ROAD KOHL'S WELLNESS CENTER
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

24811 WHITE CRK
SAN ANTONIO TX
78255-9528
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-0460
  • Fax:
Mailing address:
  • Phone: 210-313-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP116442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: