Provider Demographics
NPI:1316220262
Name:BRUNETTI, MARY BERNADETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BERNADETTE
Last Name:BRUNETTI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2332
Mailing Address - Country:US
Mailing Address - Phone:845-628-3777
Mailing Address - Fax:845-621-1339
Practice Address - Street 1:112 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-2332
Practice Address - Country:US
Practice Address - Phone:845-628-3777
Practice Address - Fax:845-621-1339
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360604163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool