Provider Demographics
NPI:1235917279
Name:BRUMBELOW, VIVIAN L (HHA)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:L
Last Name:BRUMBELOW
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2495
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:NM
Mailing Address - Zip Code:87021-2495
Mailing Address - Country:US
Mailing Address - Phone:505-240-1994
Mailing Address - Fax:
Practice Address - Street 1:1435 BERRYHILL ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:NM
Practice Address - Zip Code:87021-4223
Practice Address - Country:US
Practice Address - Phone:505-240-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide