Provider Demographics
NPI:1063234540
Name:TORI BRUEGGERT, PLLC
Entity type:Organization
Organization Name:TORI BRUEGGERT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUEGGERT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:815-529-7267
Mailing Address - Street 1:1055 CRYSTAL LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60416-7086
Mailing Address - Country:US
Mailing Address - Phone:815-529-7267
Mailing Address - Fax:
Practice Address - Street 1:1055 CRYSTAL LN
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:IL
Practice Address - Zip Code:60416-7086
Practice Address - Country:US
Practice Address - Phone:815-529-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1992231260OtherNPI