Provider Demographics
NPI:1235770280
Name:BRUCE, MEGAN (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22075
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2075
Mailing Address - Country:US
Mailing Address - Phone:503-659-4988
Mailing Address - Fax:503-698-4018
Practice Address - Street 1:16144 SE HAPPY VALLEY TOWN CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4257
Practice Address - Country:US
Practice Address - Phone:503-659-4988
Practice Address - Fax:503-698-4018
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201908774NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily