Healthcare Provider Details

I. General information

NPI: 1861852881
Provider Name (Legal Business Name): PATRICIA RENEE BRUCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 GORGAS LN
PHILADELPHIA PA
19128-2448
US

IV. Provider business mailing address

606 GORGAS LN
PHILADELPHIA PA
19128-2448
US

V. Phone/Fax

Practice location:
  • Phone: 215-399-8714
  • Fax: 215-683-1815
Mailing address:
  • Phone: 215-399-8714
  • Fax: 215-683-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN287906L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberSP004320C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: