Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | NP17496 | CA |
NPI | 1003008772 |
---|---|
Provider Name | Louise Mary Bruce |
First Address | San Jose, CA 95128-2603 |
Second Address | San Jose, CA 95126-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 08/10/2012 |