Provider Demographics
NPI:1134107188
Name:BRUCE, CHRISTINE H (PA C MHSA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:H
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PA C MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-0003
Mailing Address - Fax:717-531-5013
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-4221
Practice Address - Fax:717-531-0151
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000630L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R07446Medicare UPIN
581347Medicare ID - Type Unspecified