Ivette Mariana Brueggemann

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

10 Missile Ave
Minot AFB, ND 58705-5003

Phone

(701) 723-5190

NPI assigned

Jan 8, 2020

Last updated

Jan 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1508406596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MISSILE AVE",
            "city": "MINOT AFB",
            "state": "ND",
            "postal_code": "587055003",
            "telephone_number": "701-723-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MISSILE AVE",
            "city": "MINOT AFB",
            "state": "ND",
            "postal_code": "587055003",
            "telephone_number": "701-723-5190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUEGGEMANN",
        "first_name": "IVETTE",
        "middle_name": "MARIANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-08",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MILITARY",
            "identifier": "F3418255",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "GENESIS",
            "affiliation": "N",
            "address_1": "101 Bodin Cir",
            "city": "Travis AFB",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945351809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Victor Beals, MD
• David Joseph Bergstrom, IDMT
• Karrie Ann Bissen, MSN, RN, CCM
• Raymond Roger Bouchard, LCSW
• Erin Lynn Bradford
• Shelly Carbo, LCSW
• Carlos R Castillo, LCSW,ACSW,BCD
• Patricia Kaye Catrow, D.O.
• Amber D Clayton, LCSW
• Derek Cluff, DMD

• Independent Duty Medical Technicians in Minot AFB, ND
• Providers in Minot AFB, ND by specialty
• Independent Duty Medical Technicians in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.