Provider Demographics
NPI:1437305802
Name:MCCRUMMEN, BRENNA KOLOKOFF (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:KOLOKOFF
Last Name:MCCRUMMEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:KOLOKOFF
Other - Last Name:GJULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5085
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:980 W IRONWOOD DR STE 306
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2668
Practice Address - Country:US
Practice Address - Phone:208-625-4970
Practice Address - Fax:208-625-4991
Is Sole Proprietor?:No
Enumeration Date:2008-08-17
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11706207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology