Individual
JESSICA L. BRUGGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA.200403
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06871008
—
MS
05
—
2138596
—
LA
Enumeration date
02/04/2011
Last updated
04/25/2011
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