Provider Demographics
NPI:1760465249
Name:BRUCE, CYNTHIA L (CRNA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:BRUCE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2585
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-2585
Mailing Address - Country:US
Mailing Address - Phone:864-882-0226
Mailing Address - Fax:706-660-1454
Practice Address - Street 1:298 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9443
Practice Address - Country:US
Practice Address - Phone:864-882-3351
Practice Address - Fax:864-885-7619
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR31335367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2991Medicaid
SCAN0322Medicaid
SC400097OtherMEDICAID - GROUP
SC1152OtherMEDICARE - GROUP
SCGP2991Medicaid
SC400097OtherMEDICAID - GROUP