Provider Demographics
NPI:1154954121
Name:BRUCE, PATRICIA ANN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6396 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3669
Mailing Address - Country:US
Mailing Address - Phone:937-241-9193
Mailing Address - Fax:937-938-5008
Practice Address - Street 1:6396 STONEY CREEK DR
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3669
Practice Address - Country:US
Practice Address - Phone:937-241-9193
Practice Address - Fax:937-938-5008
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0369063Medicaid