Basic Information
| Provider Information | |||||||||
| NPI: | 1669007605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUCE | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | AMBER | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 ALLEN ST | ||||||||
| Address2: | |||||||||
| City: | KELSO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986264456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604148818 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1718 E KESSLER BLVD | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986321842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3660747580 | ||||||||
| FaxNumber: | 3605753846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2020 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N361084411 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.