Diane Ruth Bruder, CNS
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · St. Peter, MN
NPI 1124041504 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124041504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- R 102741-9 (MN)
- Practice address
- 2000 Klein Street
St. Peter, MN 56082 - Phone
- (507) 931-7192
- NPI assigned
- Jul 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 102741-9 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Center for Personal & Family Development PA | Past | Accepting new patients | |
| Community Behavioral Health Hospital-St Peter | Past | Accepting new patients | |
| Pathway Virtu-Health | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R 102741-9 | MN | Yes |
Addresses
Primary practice location
2000 Klein Street
St. Peter, MN 56082
Mailing address
2000 Klein Sstreet
St. Peter, MN 56082
Phone (507) 931-7192
Other providers in St. Peter, MN
- Benjamin Bonser
- Stephanie Bove
- Shelia M Brandt
- Margaret M Briese
- Marcius R Brock
- Charles Rodney Butler III
- Molli Cacka
- Olivia Cammers
- Jennifer Lyn Carlstrom
- Ellen Reinhard Castillo
All providers in St. Peter, MN · Psychiatric/Mental Health Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.