Provider Demographics
NPI:1427691096
Name:BRUETTE, RICHELLE L
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:L
Last Name:BRUETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17305 HWY 10
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54230
Mailing Address - Country:US
Mailing Address - Phone:920-851-6615
Mailing Address - Fax:
Practice Address - Street 1:306A LAVESTA CT.
Practice Address - Street 2:
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110
Practice Address - Country:US
Practice Address - Phone:920-754-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider