Provider Demographics
NPI:1669007605
Name:BRUCE, CHRISTINE AMBER (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:AMBER
Last Name:BRUCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-4456
Mailing Address - Country:US
Mailing Address - Phone:360-414-8818
Mailing Address - Fax:
Practice Address - Street 1:1718 E KESSLER BLVD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-1842
Practice Address - Country:US
Practice Address - Phone:366-074-7580
Practice Address - Fax:360-575-3846
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN361084411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN60485393OtherRN