Provider Demographics
NPI:1326014952
Name:BRUCE, EVELYN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 LOYOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3902
Mailing Address - Country:US
Mailing Address - Phone:310-538-2161
Mailing Address - Fax:310-538-1389
Practice Address - Street 1:738 LOYOLA AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3902
Practice Address - Country:US
Practice Address - Phone:310-538-2161
Practice Address - Fax:310-538-1389
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 15504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily