Doctor Name: | LEAH M BRUCE |
NPI Number: | 1063802403 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SAC-IT |
License Number: | |
Business Practice Address: | 121 W Main St Port Washington, WI - 530741813 |
Business Phone Number: | 2622848200 |
Business Fax Number: | 2622848104 |
Mailing Address: | 121 W Main St, PORT WASHINGTON |
State: | WI |
Postal Code: | 530741813 |
Phone Number: | 2622848200 |
Fax Number: | 2622848104 |
NPI Enumeration Date: | 01/23/2015 |
NPI Last Update Date: | 06/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |