Doctor Name: | PENNY S BRUSO |
NPI Number: | 1518376607 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 101.0105935 |
Business Practice Address: | 677 Rte 7a Shaftsbury, VT - 05262 |
Business Phone Number: | 8024428531 |
Business Fax Number: | |
Mailing Address: | Po Box 379, 677 Rte 7a SHAFTSBURY |
State: | VT |
Postal Code: | 05262 |
Phone Number: | 8024428531 |
Fax Number: | |
NPI Enumeration Date: | 08/04/2014 |
NPI Last Update Date: | 08/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 101.0105935 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |