Healthcare Provider Details

I. General information

NPI: 1689655433
Provider Name (Legal Business Name): BRUCE FEWKES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

819 CAMERON CT
VACAVILLE CA
95687-7325
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3585
  • Fax:
Mailing address:
  • Phone: 707-446-8716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-409
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: