Provider Demographics
NPI:1710965389
Name:BRUCE, THOMAS (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BRUCE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3300
Mailing Address - Country:US
Mailing Address - Phone:701-252-1050
Mailing Address - Fax:701-253-4798
Practice Address - Street 1:419 5TH ST NE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3300
Practice Address - Country:US
Practice Address - Phone:701-252-1050
Practice Address - Fax:701-253-4798
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR21818367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
3479OtherBLUE CROSS OF ND
HP42318OtherHEALTH PARTNERS
449161008624OtherPREFERRED ONE
449161008624OtherPREFERRED ONE
R02011Medicare UPIN