Provider Demographics
NPI:1336248111
Name:BRUCE, MARYANN B (CRNA)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:B
Last Name:BRUCE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:B
Other - Last Name:PRESSNALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:245 RUTH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4323
Mailing Address - Country:US
Mailing Address - Phone:651-735-0501
Mailing Address - Fax:651-735-1870
Practice Address - Street 1:69 EXCHANGE ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1004
Practice Address - Country:US
Practice Address - Phone:651-735-0501
Practice Address - Fax:651-251-8050
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0575221367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN401045100Medicaid
MN61G75BROtherBCBS
MN401045100Medicaid