Provider Demographics
NPI:1326552639
Name:BRUCK, JENNIFER (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BRUCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 HIGHWAY 191
Mailing Address - Street 2:
Mailing Address - City:PERSIA
Mailing Address - State:IA
Mailing Address - Zip Code:51563-4063
Mailing Address - Country:US
Mailing Address - Phone:712-310-2883
Mailing Address - Fax:
Practice Address - Street 1:809 ELM ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1140
Practice Address - Country:US
Practice Address - Phone:712-642-2794
Practice Address - Fax:712-642-9338
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA118193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily