Basic Information
| Provider Information | |||||||||
| NPI: | 1154793719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUCKNER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 ULLOM RD | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153018652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248098691 | ||||||||
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| Practice Location | |||||||||
| Address1: | 155 WILSON AVE | ||||||||
| Address2: | WASHINGTON HOSP | ||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153013336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003944445 | ||||||||
| FaxNumber: | 7063963252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2015 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 77260 | WV | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN586328 | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 109363 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.