Healthcare Provider Details

I. General information

NPI: 1316110729
Provider Name (Legal Business Name): CATHY SUE BRUCE RN, BSN, CCE, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8907
US

IV. Provider business mailing address

3400 HIGHWAY 78 E
JASPER AL
35501-8907
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-4858
  • Fax: 205-387-4678
Mailing address:
  • Phone: 205-387-4858
  • Fax: 205-387-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1-059127
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number1-059127
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: