Provider Demographics
NPI:1083158216
Name:BRUMMETT, GINA MARIE (HIS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 PATTERSON LN E
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2390
Mailing Address - Country:US
Mailing Address - Phone:937-875-5335
Mailing Address - Fax:
Practice Address - Street 1:3183 BEAVER VU DR STE F
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6385
Practice Address - Country:US
Practice Address - Phone:937-637-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216237700000X
OHIL.03216237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist