Provider Demographics
NPI:1538632096
Name:BRUCE, ELISE NICOLE
Entity type:Individual
Prefix:MS
First Name:ELISE
Middle Name:NICOLE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 SCHOONER CT
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-9115
Mailing Address - Country:US
Mailing Address - Phone:509-855-1725
Mailing Address - Fax:
Practice Address - Street 1:701 SCHOONER CT
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-9115
Practice Address - Country:US
Practice Address - Phone:509-855-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer