1366679979 NPI number — HELENA DAWN NICOLE BRUCE PA-C

Table of content: HELENA DAWN NICOLE BRUCE PA-C (NPI 1366679979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366679979 NPI number — HELENA DAWN NICOLE BRUCE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUCE
Provider First Name:
HELENA
Provider Middle Name:
DAWN NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366679979
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7601 RIALTO BLVD
Provider Second Line Business Mailing Address:
APT 1928
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78735-7400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 N IH 35
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78701-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-324-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  25MP00216600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 013197 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA07620 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 302843302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 876N29 . This is a "BCBS / COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 302843301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com