Provider Demographics
NPI:1326359431
Name:CUMMINGS, BRIAN (LPN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:LPN
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 143
Mailing Address - Street 2:1701 FRESHOUR RD.
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-0143
Mailing Address - Country:US
Mailing Address - Phone:585-747-3746
Mailing Address - Fax:
Practice Address - Street 1:1701 FRESHOUR RD.
Practice Address - Street 2:
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548-0143
Practice Address - Country:US
Practice Address - Phone:585-747-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291770-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse