Provider Demographics
NPI:1316581705
Name:BRUCE, ANNTERRIA
Entity type:Individual
Prefix:
First Name:ANNTERRIA
Middle Name:
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 1:1140 WESTMONT DR STE 430
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4364
Mailing Address - Country:US
Mailing Address - Phone:832-707-7042
Mailing Address - Fax:
Practice Address - Street 1:1140 WESTMONT DR STE 430
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4364
Practice Address - Country:US
Practice Address - Phone:832-707-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800034163WX0003X
TXAP145886363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Single Specialty