Provider Demographics
NPI:1083470124
Name:BRUBAKER, ELISA
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PUBLIC SQ APT 301
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-5203
Mailing Address - Country:US
Mailing Address - Phone:937-524-6312
Mailing Address - Fax:
Practice Address - Street 1:311 PUBLIC SQ APT 301
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-5203
Practice Address - Country:US
Practice Address - Phone:937-524-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant