Provider Demographics
NPI:1841546413
Name:BRUCKEN, MARLA RUDD (ARNP)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:RUDD
Last Name:BRUCKEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 LAKE CITY WAY NE # 422
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5401
Mailing Address - Country:US
Mailing Address - Phone:425-620-3072
Mailing Address - Fax:206-694-2402
Practice Address - Street 1:1424 NE 155TH ST STE 205
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7104
Practice Address - Country:US
Practice Address - Phone:425-620-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60303512363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health