Basic Information
| Provider Information | |||||||||
| NPI: | 1609053602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUHL | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | RN, MSN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SEAGATE STE 800 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241952 | ||||||||
| FaxNumber: | 4198240344 | ||||||||
| Practice Location | |||||||||
| Address1: | 5308 HARROUN RD | ||||||||
| Address2: | SUITE 055 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198246599 | ||||||||
| FaxNumber: | 4198853870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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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 | 363L00000X | RN 09796 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207RH0003X | APRN.09796 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 363L00000X | 4704263022 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | N64970005 | 01 | MI | MEDICARE PTAN | OTHER | 2831912 | 05 | OH | MEDICAID | H388051 | 01 | OH | MEDICARE PTAN | OTHER | POO904169 | 01 | OH | RRMC | OTHER | BRNP26021 | 01 | OH | MEDICARE PTAN | OTHER |