Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | LL86002 | SC |
NPI | 1003483504 |
---|---|
Provider Name | Bethany Anne Bruno |
First Address | Charleston, SC 29425-8905 |
Second Address | Charleston, SC 29425-0100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 04/06/2021 |