Provider Demographics
NPI:1760410575
Name:BRUNO, GINA C (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:C
Last Name:BRUNO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 FORD ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1268
Mailing Address - Country:US
Mailing Address - Phone:724-763-7144
Mailing Address - Fax:724-763-7161
Practice Address - Street 1:313 FORD ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-1268
Practice Address - Country:US
Practice Address - Phone:724-763-7144
Practice Address - Fax:724-763-7161
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003034L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP31319Medicare UPIN
PA047677VALMedicare ID - Type Unspecified