Provider Demographics
NPI:1760071153
Name:ANDREWS, BRUCE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 KACHINA DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-8347
Mailing Address - Country:US
Mailing Address - Phone:575-840-5335
Mailing Address - Fax:
Practice Address - Street 1:1405 N UNION AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-8269
Practice Address - Country:US
Practice Address - Phone:575-622-4633
Practice Address - Fax:575-622-4497
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM62404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily