Provider Demographics
NPI:1023654548
Name:BRUDER, JARED EDWARD (ARNP)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:EDWARD
Last Name:BRUDER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W PARK PL STE 303
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2784
Mailing Address - Country:US
Mailing Address - Phone:208-261-2255
Mailing Address - Fax:208-473-7271
Practice Address - Street 1:1110 W PARK PL STE 320
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2783
Practice Address - Country:US
Practice Address - Phone:208-261-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID67924363L00000X
WAAP61017581363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner