Individual
MR. BRUCE RICHARD BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0001
(414) 384-2000
Mailing address
2232 W GLEN HILLS CT, GLENDALE, WI 53209-3353
(414) 540-0772
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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