=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528971199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHANY BRUEGGEN BSN, SANE-A, SANE-P
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2026
-----------------------------------------------------
Last Update Date | 09/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75-5400 NANAINA PL
-----------------------------------------------------
City | HOLUALOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96725-9645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-402-9819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 142
-----------------------------------------------------
City | HOLUALOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96725-0142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-402-9819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 116979
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------