Provider Demographics
NPI:1760635692
Name:BRUCE, MARIE LOUISE (APNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:L
Other - Last Name:SOBIECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36500 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4899
Mailing Address - Country:US
Mailing Address - Phone:262-434-5000
Mailing Address - Fax:262-434-5050
Practice Address - Street 1:36500 AURORA DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:262-434-5000
Practice Address - Fax:262-434-5050
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3543363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760635692Medicaid
WIK400341149Medicare PIN