Provider Demographics
NPI:1043348998
Name:BRUCKBAUER, ELIZABETH A (APRN, BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BRUCKBAUER
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Gender:F
Credentials:APRN, BC
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Mailing Address - Street 1:333 E CAMPUS MALL
Mailing Address - Street 2:MAILROOM 8104
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1365
Mailing Address - Country:US
Mailing Address - Phone:608-262-9640
Mailing Address - Fax:608-262-9160
Practice Address - Street 1:333 E CAMPUS MALL
Practice Address - Street 2:MAILROOM 8104
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1365
Practice Address - Country:US
Practice Address - Phone:608-262-9640
Practice Address - Fax:608-262-9160
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2015-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI82057-030163WC1400X
WI96-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health