Individual
BRUCE WALTER FILLERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
900 BUFFALO ST, JOHNSON CITY, TN 37604-6720
(423) 232-4130
(423) 467-3644
Mailing address
1167 SPRATLIN PARK DR, GRAY, TN 37615-6205
(423) 467-3721
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN0000039119
TN
Other
Enumeration date
03/12/2009
Last updated
03/12/2009
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