Provider Demographics
NPI:1609833722
Name:GUMM, SHIRLEY BROOK (RN CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:BROOK
Last Name:GUMM
Suffix:
Gender:F
Credentials:RN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-8202
Mailing Address - Country:US
Mailing Address - Phone:513-381-2247
Mailing Address - Fax:513-381-2256
Practice Address - Street 1:5 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-8202
Practice Address - Country:US
Practice Address - Phone:513-381-2247
Practice Address - Fax:513-381-2256
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4173363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics