Provider Demographics
NPI:1437288958
Name:BRUNO, KEESHA NICOLA (FNP)
Entity Type:Individual
Prefix:MS
First Name:KEESHA
Middle Name:NICOLA
Last Name:BRUNO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 YORK AVE
Mailing Address - Street 2:10TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5663
Mailing Address - Country:US
Mailing Address - Phone:646-962-7246
Mailing Address - Fax:212-746-2023
Practice Address - Street 1:530 EAST 70TH STREET
Practice Address - Street 2:M-0026
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-746-7246
Practice Address - Fax:212-746-2023
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP009174OtherFNP LICENSE
PARN568989OtherRN LICENSE
NY510958OtherRN LICENSE
NYF334881OtherFNP LICENSE
NY02975060Medicaid
NY056XL23571OtherMEDICARE