Healthcare Provider Details

I. General information

NPI: 1659122653
Provider Name (Legal Business Name): CHELSEA M. BRUCKER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MORNING SUN RD STE B
OXFORD OH
45056-9546
US

IV. Provider business mailing address

5151 MORNING SUN RD STE B
OXFORD OH
45056-9546
US

V. Phone/Fax

Practice location:
  • Phone: 513-524-5522
  • Fax: 513-664-3956
Mailing address:
  • Phone: 513-524-5522
  • Fax: 513-664-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02240355
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0036010
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.409143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: