Provider Demographics
NPI:1629237979
Name:BRUCE, KATHLEEN B (RN IBCLC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:B
Last Name:BRUCE
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3594 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8719
Mailing Address - Country:US
Mailing Address - Phone:802-879-8854
Mailing Address - Fax:
Practice Address - Street 1:3594 SOUTH RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8719
Practice Address - Country:US
Practice Address - Phone:802-879-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist