Provider Demographics
NPI:1538440052
Name:BRUCKMEIER, JAN E (APRN)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:E
Last Name:BRUCKMEIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 LONESOME RD
Mailing Address - Street 2:STE A
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7085
Mailing Address - Country:US
Mailing Address - Phone:985-246-2600
Mailing Address - Fax:985-246-2601
Practice Address - Street 1:4050 LONESOME RD
Practice Address - Street 2:STE A
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7085
Practice Address - Country:US
Practice Address - Phone:985-246-2600
Practice Address - Fax:985-246-2601
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02518363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health