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General NPI Number Information
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NPI Number | 1871795955
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Entity Type | Individual
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Provider Name | KRISTEN INGRID BRUNO MD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 03/19/2023
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Provider Practice Location Address
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Address Line | 706 N MAIN ST
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City | O FALLON
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State | MO
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Zip | 63366-1743
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Country | US
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Telephone | 314-258-5941
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Fax | 314-279-0255
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Provider Business Mailing Address
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Address Line | 1181 LOCKETT RD
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City | DES PERES
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State | MO
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Zip | 63131-4234
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Country | US
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Telephone | 314-258-5941
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2007007759
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License Number State | MO
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