Provider Demographics
NPI:1407407026
Name:PURNELL, BRIGITTE D
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:D
Last Name:PURNELL
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 1:1908 W QUARTERMASTER ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6627
Mailing Address - Country:US
Mailing Address - Phone:909-762-0107
Mailing Address - Fax:
Practice Address - Street 1:1908 W QUARTERMASTER ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6627
Practice Address - Country:US
Practice Address - Phone:909-762-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty