Provider Demographics
NPI:1417422031
Name:BRUCE, ANNA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:ALLAIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3151 SAINT BURY CT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-6459
Mailing Address - Country:US
Mailing Address - Phone:605-209-4618
Mailing Address - Fax:
Practice Address - Street 1:741 MT VIEW RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2540
Practice Address - Country:US
Practice Address - Phone:605-791-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily