Individual
LOLITA THOMAS BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
920 2ND AVE S STE 400, MINNEAPOLIS, MN 55402-3318
(612) 225-1538
Mailing address
920 2ND AVE S STE 400, MINNEAPOLIS, MN 55402-3318
(612) 225-1538
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04817
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2035487-01
—
TX
05
—
2067738-01
—
TX
05
—
206773801
—
TX
05
—
206773802
—
TX
01
—
D07564
MEDICARE RR PALMETTO
TX
01
—
DQ5280
MEDICARE RR PALMETTO
TX
Enumeration date
12/27/2007
Last updated
05/24/2012
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