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General NPI Number Information
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NPI Number | 1023254018
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Entity Type | Individual
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Provider Name | PAMELA SUE BRUCKER LPN
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Gender | Female
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | W7755 CTY RD V
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City | CASCADE
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State | WI
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Zip | 53011-1234
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Country | US
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Telephone | 920-528-8198
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Fax | 920-528-7056
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Provider Business Mailing Address
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Address Line | W 7755 CTY. RD. V
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City | CASCADE
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State | WI
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Zip | 53011-1234
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Country | US
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Telephone | 920-528-8198
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Fax | 920-528-7056
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 14165-031
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License Number State | WI
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