Provider Demographics
NPI:1326323999
Name:BRUCE, VERONICA HELENE (CNS)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:HELENE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 W RIVER PARK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-5192
Mailing Address - Country:US
Mailing Address - Phone:530-577-4308
Mailing Address - Fax:530-577-4308
Practice Address - Street 1:3313 W RIVER PARK RD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-5192
Practice Address - Country:US
Practice Address - Phone:530-577-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2502364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist