Provider Demographics
NPI:1518145895
Name:BRUMMETT, GENEVA C (FNP)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:C
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47390-1039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 W DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:IN
Practice Address - Zip Code:47390-1039
Practice Address - Country:US
Practice Address - Phone:765-964-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002559A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200895830Medicaid
IN558430059Medicare PIN