Provider Demographics
NPI:1306098777
Name:BRUEGGEMANN, SERINA TONYA (CRNA)
Entity type:Individual
Prefix:
First Name:SERINA
Middle Name:TONYA
Last Name:BRUEGGEMANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SERINA
Other - Middle Name:TONYA
Other - Last Name:GEIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:111 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4815
Mailing Address - Country:US
Mailing Address - Phone:414-290-6720
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:865-342-8900
Practice Address - Fax:865-691-0843
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1311367500000X
MNR1617175367500000X
WI3725-33367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1306098777Medicaid
WI1306098777Medicaid