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General NPI Number Information
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NPI Number | 1689489510
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Entity Type | Individual
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Provider Name | KRISTIN BRUCKMAN NP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 5412 COURSEVIEW DR STE 215
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City | MASON
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State | OH
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Zip | 45040-2410
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Country | US
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Telephone | 513-204-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 4095 BROOKDALE LN UNIT 6
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City | DAYTON
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State | OH
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Zip | 45440-4187
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Country | US
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Telephone | 937-361-0192
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0038456
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License Number State | OH
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