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NPI Code Detail

MEDICARE: AMY BRUGGEMANN FNP

MEDICARE: AMY BRUGGEMANN FNP
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
1363LF0000XFamily Nurse Practitioner209005238IL

General Provider Information

NPI Number : 1972509339
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY BRUGGEMANN FNP
Provider Business Mailing Address
First Line : 2500 EXECUTIVE DRIVE
Second Line : SUITE 104
City : ST. CHARLES
State : MO
Zip : 63303
Country : US
Telephone Number : 888-811-4677
Fax Number : 800-605-8906
Provider Business Practice Location Address
First Line : 40 N 64TH ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62223-3808
Country : US
Telephone Number : 618-397-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 12/02/2014

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