1437100302 NPI number — DEBORA SANTOS BRUNO M.D.

Table of content: CATRINA LOWANCE (NPI 1326602632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437100302 NPI number — DEBORA SANTOS BRUNO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNO
Provider First Name:
DEBORA
Provider Middle Name:
SANTOS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437100302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
702 W 35TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68901-7385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-460-5899
Provider Business Mailing Address Fax Number:
402-460-5619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 N KANSAS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68901-4470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-460-5899
Provider Business Practice Location Address Fax Number:
402-460-5619
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  23664 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 249581 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 30418 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 200385920A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025662600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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