Healthcare Provider Details

I. General information

NPI: 1831993476
Provider Name (Legal Business Name): ROBERT WAYNE BRUCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W CHEYENNE AVE APT 2012
NORTH LAS VEGAS NV
89030-7875
US

IV. Provider business mailing address

1200 W CHEYENNE AVE APT 2012
NORTH LAS VEGAS NV
89030-7875
US

V. Phone/Fax

Practice location:
  • Phone: 702-831-0369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number9952
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: