Healthcare Provider Details

I. General information

NPI: 1215814264
Provider Name (Legal Business Name): KAREN MARIE BRUCHAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 BRODHEAD RD
BETHLEHEM PA
18017-8938
US

IV. Provider business mailing address

5118 FAITH AVE
COOPERSBURG PA
18036-1306
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5700
  • Fax:
Mailing address:
  • Phone: 484-226-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN723141
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033710
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: