Provider Demographics
NPI:1477807402
Name:BRIMMER, ADRIENNE LARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LARIE
Last Name:BRIMMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:LARIE
Other - Last Name:CEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:61 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-1400
Mailing Address - Country:US
Mailing Address - Phone:315-298-6564
Mailing Address - Fax:315-298-7831
Practice Address - Street 1:16 FRAVOR RD
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3011
Practice Address - Country:US
Practice Address - Phone:315-963-8400
Practice Address - Fax:315-630-3169
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337376363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner