Provider Demographics
NPI:1598440737
Name:BRUMFIELD, MICHELLE (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6582 MALLORY CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3023
Mailing Address - Country:US
Mailing Address - Phone:213-220-6639
Mailing Address - Fax:
Practice Address - Street 1:4280 LATHAM ST STE H
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1737
Practice Address - Country:US
Practice Address - Phone:213-220-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA741856163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse