MEDICARE: SELENA BRUCK

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
1	363LP2300X	Primary Care Nurse Practitioner	PENDING	OH

General Provider Information

NPI Number	:	1336756956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA BRUCK

Provider Business Mailing Address
First Line	:	29101 HEALTH CAMPUS DR STE 250
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-5277
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29101 HEALTH CAMPUS DR STE 250
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-5277
Country	:	US
Telephone Number	:	440-827-5195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	02/19/2026

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Directions to “ SELENA BRUCK ” Practice Location

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