Healthcare Provider Details

I. General information

NPI: 1790416147
Provider Name (Legal Business Name): MARCIA K THOMAS BRUCE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 GROS BLVD
HERKIMER NY
13350-1446
US

IV. Provider business mailing address

13 GIBSON ST
DOLGEVILLE NY
13329-1203
US

V. Phone/Fax

Practice location:
  • Phone: 315-867-2000
  • Fax:
Mailing address:
  • Phone: 315-985-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number585259
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: