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NPI Code Detail

MEDICARE: SIERRA MARIE BRUCE

MEDICARE: SIERRA MARIE BRUCE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WA0400XAddiction (Substance Use Disorder) Registered Nurse488537OH
2164W00000XLicensed Practical Nurse161537OH
3163W00000XRegistered Nurse488537OH

General Provider Information

NPI Number : 1255825691
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIERRA MARIE BRUCE
Provider Business Mailing Address
First Line : PO BOX 55
Second Line :
City : WALTON
State : KY
Zip : 41094-0055
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 220 S BREIEL BLVD
Second Line :
City : MIDDLETOWN
State : OH
Zip : 45044-5106
Country : US
Telephone Number : 513-849-8670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2018
Last Update Date : 11/09/2022

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Directions to “ SIERRA MARIE BRUCE ” Practice Location

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