Provider Demographics
NPI:1477263648
Name:BRUEN, STEFANIA PATANIA (RN)
Entity Type:Individual
Prefix:
First Name:STEFANIA
Middle Name:PATANIA
Last Name:BRUEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STEFANIA
Other - Middle Name:PAOLA
Other - Last Name:PATANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2475 JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2742
Mailing Address - Country:US
Mailing Address - Phone:585-237-8339
Mailing Address - Fax:
Practice Address - Street 1:2475 JEFFERSON TER
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2742
Practice Address - Country:US
Practice Address - Phone:585-237-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN310611163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse