Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | PENDING | IN |
NPI | 1578102950 |
---|---|
Provider Name | Leslie Bruchey |
First Address | Westminster, MD 21158-9421 |
Second Address | Indianapolis, IN 46260-5925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2020 |
Last Update Date | 02/01/2020 |