Provider Demographics
NPI:1841470101
Name:BRUNO, GWEN ELIZABETH (ADULT NURSE PRACTITI)
Entity type:Individual
Prefix:MS
First Name:GWEN
Middle Name:ELIZABETH
Last Name:BRUNO
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3332
Mailing Address - Country:US
Mailing Address - Phone:716-712-0670
Mailing Address - Fax:716-712-0674
Practice Address - Street 1:1900 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-712-0670
Practice Address - Fax:716-712-0674
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3039461363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health