MEDICARE: CHARLOTTE ANN BRURUD LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	1964	MT

General Provider Information

NPI Number	:	1538400817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE ANN BRURUD LPN

Provider Business Mailing Address
First Line	:	5790 US HIGHWAY 89
Second Line	:
City	:	BELT
State	:	MT
Zip	:	59412-8422
Country	:	US
Telephone Number	:	406-799-0253
Fax Number	:

Provider Business Practice Location Address
First Line	:	5790 US HIGHWAY 89
Second Line	:
City	:	BELT
State	:	MT
Zip	:	59412-8422
Country	:	US
Telephone Number	:	406-799-0253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2013
Last Update Date	:	03/11/2013

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Directions to “ CHARLOTTE ANN BRURUD LPN” Practice Location

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