Provider Demographics
NPI:1851016133
Name:BRUNO ROBERTS, AMANDA (ACNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BRUNO ROBERTS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE NEDDICK
Mailing Address - State:ME
Mailing Address - Zip Code:03902-7446
Mailing Address - Country:US
Mailing Address - Phone:207-451-7854
Mailing Address - Fax:
Practice Address - Street 1:103 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CAPE NEDDICK
Practice Address - State:ME
Practice Address - Zip Code:03902-7446
Practice Address - Country:US
Practice Address - Phone:207-451-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH089696-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care