Provider Demographics
NPI:1811172182
Name:BRUNO, ALICIA MARIE (CNP)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIE
Last Name:BRUNO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5981 JEFFERSON ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3457
Mailing Address - Country:US
Mailing Address - Phone:505-370-9600
Mailing Address - Fax:505-355-0566
Practice Address - Street 1:5981 JEFFERSON ST NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3457
Practice Address - Country:US
Practice Address - Phone:505-370-9600
Practice Address - Fax:505-355-0566
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR33931363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM100101Medicare PIN