Provider Demographics
NPI:1063165124
Name:BRUNO, CLAIRE (RD)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 N LEAVITT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5688
Mailing Address - Country:US
Mailing Address - Phone:773-612-0867
Mailing Address - Fax:
Practice Address - Street 1:150 E HURON ST FL 13
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2999
Practice Address - Country:US
Practice Address - Phone:312-858-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007898133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164007898OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL86156698OtherCOMMISSION ON DIETETIC REGISTRATION