Provider Demographics
NPI:1861852881
Name:BRUCE, PATRICIA RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:RENEE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 GORGAS LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2448
Mailing Address - Country:US
Mailing Address - Phone:215-399-8714
Mailing Address - Fax:215-683-1815
Practice Address - Street 1:606 GORGAS LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2448
Practice Address - Country:US
Practice Address - Phone:215-399-8714
Practice Address - Fax:215-683-1815
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN287906L163WA2000X
PASP004320C163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator