Provider Demographics
NPI:1003008772
Name:BRUCE, LOUISE MARY (FNP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:MARY
Last Name:BRUCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LOUISE
Other - Middle Name:MARY
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:750 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2603
Mailing Address - Country:US
Mailing Address - Phone:408-885-4650
Mailing Address - Fax:408-885-3505
Practice Address - Street 1:1691 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2203
Practice Address - Country:US
Practice Address - Phone:408-287-7526
Practice Address - Fax:408-971-6963
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily