Provider Demographics
NPI:1942735394
Name:ARMWALD, BRUIN CRAIG
Entity Type:Individual
Prefix:
First Name:BRUIN
Middle Name:CRAIG
Last Name:ARMWALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WAUPELANI DR APT A106
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4545
Mailing Address - Country:US
Mailing Address - Phone:608-575-9796
Mailing Address - Fax:
Practice Address - Street 1:201 HASTINGS RD
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4545
Practice Address - Country:US
Practice Address - Phone:814-865-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART006506405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional