Provider Demographics
NPI:1346460730
Name:BRUMFIELD, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BRUMFIELD
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 1:127 N JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9337
Mailing Address - Country:US
Mailing Address - Phone:509-422-6593
Mailing Address - Fax:509-422-0907
Practice Address - Street 1:900 FERRY ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3405
Practice Address - Country:US
Practice Address - Phone:509-662-2013
Practice Address - Fax:509-422-0907
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005970363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7103203Medicaid