Healthcare Provider Details

I. General information

NPI: 1144256553
Provider Name (Legal Business Name): KELLY ANN BRUHN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N KING DR MILWAUKEE HEALTH SERVICES INC
MILWAUKEE WI
53212-2709
US

IV. Provider business mailing address

2555 N KING DR MILWAUKEE HEALTH SERVICES INC
MILWAUKEE WI
53212-2709
US

V. Phone/Fax

Practice location:
  • Phone: 414-372-8080
  • Fax: 414-372-7425
Mailing address:
  • Phone: 414-372-8080
  • Fax: 414-372-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number148789-032
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: