Healthcare Provider Details

I. General information

NPI: 1013422682
Provider Name (Legal Business Name): STEPHANIE ELLEN BRUNO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE E SHANK

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 AMHERST ST STE 201
WINCHESTER VA
22601-2894
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 210
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-2339
  • Fax: 540-450-2333
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024180253
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number111393
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: