Provider Demographics
NPI:1346471083
Name:BRUMMEL, NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BRUMMEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 28TH AVE SW
Mailing Address - Street 2:STE #2
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-3927
Mailing Address - Country:US
Mailing Address - Phone:515-967-3046
Mailing Address - Fax:515-957-9573
Practice Address - Street 1:950 28TH AVE SW
Practice Address - Street 2:STE #2
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-3927
Practice Address - Country:US
Practice Address - Phone:515-967-3046
Practice Address - Fax:515-957-9573
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice