Provider Demographics
NPI:1417570581
Name:BRUCKBAUER, H. CLAIRE
Entity Type:Individual
Prefix:
First Name:H.
Middle Name:CLAIRE
Last Name:BRUCKBAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 CURRIE AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3002
Mailing Address - Country:US
Mailing Address - Phone:414-453-6446
Mailing Address - Fax:
Practice Address - Street 1:5790 S 27TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-4129
Practice Address - Country:US
Practice Address - Phone:414-282-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
657685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered