MEDICARE: MS. MICHELLE ANTOINETTE BRUCE LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	X07076	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356656466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE ANTOINETTE BRUCE LMSW

Provider Business Mailing Address
First Line	:	PO BOX 349
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0349
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:	575-355-7894

Provider Business Practice Location Address
First Line	:	546 N. 10TH ST
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0349
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:	575-355-7894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	08/08/2011

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