Provider Demographics
NPI:1184280687
Name:CHAFFEE, BRUCE JAMES (FNP)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:JAMES
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 TAFT AVE NE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4626
Mailing Address - Country:US
Mailing Address - Phone:218-766-4007
Mailing Address - Fax:
Practice Address - Street 1:RED LAKE HOSPITAL
Practice Address - Street 2:24760 HOSPITAL DRIVE
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-5667
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily