Provider Demographics
NPI:1457433047
Name:BRUCE, SUSAN ESTHER (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ESTHER
Last Name:BRUCE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ESTHER
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:14994 E LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:ARP
Mailing Address - State:TX
Mailing Address - Zip Code:75750-9781
Mailing Address - Country:US
Mailing Address - Phone:903-859-3403
Mailing Address - Fax:903-859-3403
Practice Address - Street 1:14994 E LAKE CIR
Practice Address - Street 2:
Practice Address - City:ARP
Practice Address - State:TX
Practice Address - Zip Code:75750-9781
Practice Address - Country:US
Practice Address - Phone:903-859-3403
Practice Address - Fax:903-859-3403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531189367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531189OtherTEXAS STATE NURSING LICEN