Healthcare Provider Details

I. General information

NPI: 1184181984
Provider Name (Legal Business Name): NICOLE YVONNE BRUNO RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E FOURTH PLAIN BLVD
VANCOUVER WA
98661-3965
US

IV. Provider business mailing address

1050 LARRABEE AVE STE 104 PMB 466
BELLINGHAM WA
98225
US

V. Phone/Fax

Practice location:
  • Phone: 360-852-9092
  • Fax: 360-397-4368
Mailing address:
  • Phone: 360-961-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN60765681
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60765681
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: