Provider Demographics
NPI:1558429555
Name:BRUINSMA, ARLENE (RN)
Entity Type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:
Last Name:BRUINSMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SUNRISE AVE
Mailing Address - Street 2:SUITE A16
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4519
Mailing Address - Country:US
Mailing Address - Phone:916-607-7888
Mailing Address - Fax:916-961-1270
Practice Address - Street 1:901 SUNRISE AVE
Practice Address - Street 2:SUITE A16
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4519
Practice Address - Country:US
Practice Address - Phone:916-607-7888
Practice Address - Fax:916-961-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA186496364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ38081ZMedicare ID - Type Unspecified