Individual
MRS. TIA BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
303 N KEENE ST, SUITE 404, COLUMBIA, MO 65201-7193
(573) 777-7627
Mailing address
816 S CENTRAL AVE, CENTRALIA, MO 65240-1810
(573) 819-0954
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2015044321
MO
Other
Enumeration date
08/10/2016
Last updated
08/10/2016
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