Individual
MRS. SUSAN R BRUST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCH NP, CNS
Contact information
Practice address
1100 LAKE VIEW DR, WAUSAU, WI 54403-6799
(715) 848-4600
Mailing address
N1736 20TH RD, WAUTOMA, WI 54982-5920
(507) 269-1841
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
8103
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
8103-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R1306952
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125674
MMSI
MN
05
—
1351033600
—
MN
01
—
162P6BR
BCBS IND NUMBER
MN
01
—
164P4SU
BCBS GROUP NUMBER
MN
01
—
83-60115
UBH
MN
Enumeration date
08/18/2006
Last updated
03/30/2021
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