Provider Demographics
NPI:1053860288
Name:BRUSO, ZETRA COLETTE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:ZETRA
Middle Name:COLETTE
Last Name:BRUSO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3625
Mailing Address - Country:US
Mailing Address - Phone:518-335-3773
Mailing Address - Fax:
Practice Address - Street 1:37 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992-2562
Practice Address - Country:US
Practice Address - Phone:518-562-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY550619163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool