Provider Demographics
NPI:1538400817
Name:BRURUD, CHARLOTTE ANN (LPN)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ANN
Last Name:BRURUD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5790 US HIGHWAY 89
Mailing Address - Street 2:
Mailing Address - City:BELT
Mailing Address - State:MT
Mailing Address - Zip Code:59412-8422
Mailing Address - Country:US
Mailing Address - Phone:406-799-0253
Mailing Address - Fax:
Practice Address - Street 1:5790 US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:BELT
Practice Address - State:MT
Practice Address - Zip Code:59412-8422
Practice Address - Country:US
Practice Address - Phone:406-799-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1964164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse