Provider Demographics
NPI:1760887038
Name:BRUCE, PETRA (R N, PHN, BSN)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:R N, PHN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 INDIGO HILLS DR UNIT 5
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7889
Mailing Address - Country:US
Mailing Address - Phone:951-733-1267
Mailing Address - Fax:
Practice Address - Street 1:2225 INDIGO HILLS DR UNIT 5
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7889
Practice Address - Country:US
Practice Address - Phone:951-733-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500131163W00000X, 163WM0102X, 163WN0002X, 163WP0200X, 163WP0808X, 163WP2201X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient