Provider Demographics
NPI:1396255493
Name:RUBLE, BRANDON S (NP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:S
Last Name:RUBLE
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:1411 E PRIMROSE ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4377
Mailing Address - Country:US
Mailing Address - Phone:417-882-1207
Mailing Address - Fax:417-881-7268
Practice Address - Street 1:3801 S NATIONAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7268
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2023-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010029945163W00000X
MO2017037191363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse