Provider Demographics
NPI:1194352633
Name:BRUNO, NICOLE IMELDA (CPO, MSOP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:IMELDA
Last Name:BRUNO
Suffix:
Gender:F
Credentials:CPO, MSOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2620
Mailing Address - Country:US
Mailing Address - Phone:509-624-3314
Mailing Address - Fax:509-747-0952
Practice Address - Street 1:514 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2620
Practice Address - Country:US
Practice Address - Phone:509-624-3314
Practice Address - Fax:509-747-0952
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist