Provider Demographics
NPI:1326407677
Name:BRUMBACK, BRIANNE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:BRIANNE
Middle Name:
Last Name:BRUMBACK
Suffix:
Gender:F
Credentials:LMP
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 329
Mailing Address - Street 2:
Mailing Address - City:NAPAVINE
Mailing Address - State:WA
Mailing Address - Zip Code:98565-0329
Mailing Address - Country:US
Mailing Address - Phone:360-266-8800
Mailing Address - Fax:360-266-8700
Practice Address - Street 1:355 LINHART AVE.NE
Practice Address - Street 2:
Practice Address - City:NAPAVINE
Practice Address - State:WA
Practice Address - Zip Code:98565
Practice Address - Country:US
Practice Address - Phone:360-266-8800
Practice Address - Fax:360-266-8700
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60225803174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist