Provider Demographics
NPI:1659122653
Name:BRUCKER, CHELSEA M (CNP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:M
Last Name:BRUCKER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MORNING SUN RD STE B
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-9546
Mailing Address - Country:US
Mailing Address - Phone:513-524-5522
Mailing Address - Fax:513-664-3956
Practice Address - Street 1:5151 MORNING SUN RD STE B
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-9546
Practice Address - Country:US
Practice Address - Phone:513-524-5522
Practice Address - Fax:513-664-3956
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.409143163W00000X
OHF02240355363LF0000X
OHAPRN.CNP.0036010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse