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General NPI Number Information
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NPI Number | 1962029132
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Entity Type | Individual
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Provider Name | DANIELLE BRUCE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 500 GREAT OAKS DR STE 14
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City | MONROE
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State | GA
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Zip | 30655-8228
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Country | US
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Telephone | 770-267-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 92 GATES MILL DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7134
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN230846
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN230846
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License Number State | GA
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