MEDICARE: BRUCE TOTAL WELLNESS LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1588535686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE TOTAL WELLNESS LLC

Provider Business Mailing Address
First Line	:	PO BOX 259
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60454-0259
Country	:	US
Telephone Number	:	312-588-9449
Fax Number	:	630-381-5279

Provider Business Practice Location Address
First Line	:	10544 S HARLEM AVE STE 208
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-2063
Country	:	US
Telephone Number	:	312-588-9449
Fax Number	:	630-381-5279

Authorized Official
Title or Position	:	CEO/NURSE PRACTITIONER
Name	:	TASHIA BRUCE
Credential	:	FNP
Telephone Number	:	231-638-3389

Provider Enumeration Date	:	09/13/2025
Last Update Date	:	09/13/2025

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