MEDICARE: MS. B J BRUNING LBSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	24040	TX

General Provider Information

NPI Number	:	1699806562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. B J BRUNING LBSW

Provider Business Mailing Address
First Line	:	571 HEWLETT DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4963
Country	:	US
Telephone Number	:	505-891-1548
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 HOMESTEAD RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1293
Country	:	US
Telephone Number	:	505-248-4901
Fax Number	:	505-248-4199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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