Basic Information
| Provider Information | |||||||||
| NPI: | 1245724137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUGUERA | ||||||||
| FirstName: | SUELLEN | ||||||||
| MiddleName: | RANEE | ||||||||
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| Credential: | APRN-FNP -BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1805 S BLAINE ST | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688036154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029840853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2620 W FAIDLEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688034205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083844600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2018 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 112480 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.