Provider Demographics
NPI:1528183712
Name:BRUMLEY, LINDA SUE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:BRUMLEY
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 1:415 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1235
Mailing Address - Country:US
Mailing Address - Phone:937-544-3337
Mailing Address - Fax:
Practice Address - Street 1:415 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1235
Practice Address - Country:US
Practice Address - Phone:937-544-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2649772174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2649772Medicare UPIN