Individual
KATHARINE BRUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 906-3875
Mailing address
717 MONROE AVE, GLENSIDE, PA 19038-2606
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
SP023044
PA
Other
Enumeration date
11/02/2022
Last updated
11/02/2022
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