Healthcare Provider Details

I. General information

NPI: 1760410575
Provider Name (Legal Business Name): GINA CAROLYN BRUNO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 FRANKLIN HEALTH CMNS
FARMINGTON ME
04938-6142
US

IV. Provider business mailing address

131 FRANKLIN HEALTH CMNS
FARMINGTON ME
04938-6142
US

V. Phone/Fax

Practice location:
  • Phone: 207-860-4090
  • Fax: 207-860-4098
Mailing address:
  • Phone: 207-860-4090
  • Fax: 207-860-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2702
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: