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General NPI Number Information
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NPI Number | 1770446221
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Entity Type | Individual
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Provider Name | BRAD MICAHAEL RUESCH
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Gender | Male
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 744 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-3505
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Country | US
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Telephone | 920-530-4566
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Fax |
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Provider Business Mailing Address
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Address Line | 8117 PRESTON RD STE 800
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City | DALLAS
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State | TX
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Zip | 75225-6328
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Country | US
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Telephone |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 17779-33
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License Number State | WI
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