Provider Demographics
NPI:1407630114
Name:BRUICH, CAROLYN A (RN, IBCLC, RLC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:A
Last Name:BRUICH
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 W COMMERCE ST STE 8429
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:254-749-2343
Mailing Address - Fax:
Practice Address - Street 1:8201 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-2425
Practice Address - Country:US
Practice Address - Phone:254-749-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675043163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty