Provider Demographics
NPI:1003120510
Name:BRUECK, REBECCA NICOLE (MSN RN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:NICOLE
Last Name:BRUECK
Suffix:
Gender:F
Credentials:MSN RN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1904 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-8522
Mailing Address - Country:US
Mailing Address - Phone:269-256-6542
Mailing Address - Fax:269-256-6179
Practice Address - Street 1:1904 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-8522
Practice Address - Country:US
Practice Address - Phone:269-256-6542
Practice Address - Fax:269-256-6179
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704277738363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1708146Medicaid