Provider Demographics
NPI:1083850853
Name:BRUCE, LORRAINE L (LPN)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:L
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 OLD WEST RD
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1119
Mailing Address - Country:US
Mailing Address - Phone:518-792-4858
Mailing Address - Fax:
Practice Address - Street 1:180 OLD WEST RD
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1119
Practice Address - Country:US
Practice Address - Phone:518-792-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262462-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse