Mary Eileen Johnston Bruno, ANP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

209010075 Issued in IL

Practice address

20646 Abbey Woods CT. N.
Suite 201
Frankfort, IL 60423-3162

Phone

(866) 216-5708

Fax

(866) 216-5707

NPI assigned

May 20, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other names 1

• Ms. Mary Eileen Johnston Bruno Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382400000000",
    "number": "1669639480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20646 ABBEY WOODS CT. N.",
            "address_2": "SUITE 201",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604233162",
            "telephone_number": "866-216-5708",
            "fax_number": "866-216-5707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20646 ABBEY WOODS CT. N.",
            "address_2": "SUITE 201",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604233162",
            "telephone_number": "866-216-5708",
            "fax_number": "866-216-5707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON BRUNO",
        "first_name": "MARY",
        "middle_name": "EILEEN",
        "name_prefix": "Ms.",
        "credential": "ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-20",
        "last_updated": "2013-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC2100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Continence Care",
            "state": "IL",
            "license": "209-003545",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "IL",
            "license": "209-003545",
            "primary": false
        },
        {
            "code": "163WX1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ostomy Care",
            "state": "IL",
            "license": "209-003545",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209010075",
            "primary": true
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "IL",
            "license": "209003545",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "JOHNSTON BRUNO",
            "middle_name": "EILEEN",
            "prefix": "MS.",
            "credential": "CWOCN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Adult Health Nurse Practitioner in Frankfort, IL
• Providers in Frankfort, IL by specialty
• Adult Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.