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General NPI Number Information
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NPI Number | 1003120510
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Entity Type | Individual
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Provider Name | REBECCA NICOLE BRUECK MSN RN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 836 N DETROIT ST
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City | LAGRANGE
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State | IN
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Zip | 46761-1112
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Country | US
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Telephone | 260-499-3019
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Fax | 260-499-3022
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Provider Business Mailing Address
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Address Line | 2621 E JEFFERSON ST
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City | WARSAW
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State | IN
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Zip | 46580-3880
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Country | US
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Telephone | 574-267-7169
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Fax | 574-269-4189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704277738
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71017278A
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License Number State | IN
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