Provider Demographics
NPI:1689796823
Name:BRUSO, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BRUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MOTE STREET
Mailing Address - Street 2:BOX 141
Mailing Address - City:RARDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45671
Mailing Address - Country:US
Mailing Address - Phone:740-372-7876
Mailing Address - Fax:
Practice Address - Street 1:111 MOTE STREET
Practice Address - Street 2:BOX 141
Practice Address - City:RARDEN
Practice Address - State:OH
Practice Address - Zip Code:45671
Practice Address - Country:US
Practice Address - Phone:740-372-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2661516Medicare ID - Type UnspecifiedHOME HEALTH AIDE