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Individual
MR. BRUCE RICHARD BACON
Active
Individual
MR. BRUCE RICHARD BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163WR0400X
Rehabilitation Registered Nurse
Primary
122292-30
WI
Other
Enumeration date
08/05/2006
Last updated
07/08/2007
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