Provider Demographics
NPI:1659707537
Name:BRUMFIELD, TERRIANNA AMINA (LPN)
Entity Type:Individual
Prefix:
First Name:TERRIANNA
Middle Name:AMINA
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0230
Mailing Address - Country:US
Mailing Address - Phone:518-534-8385
Mailing Address - Fax:
Practice Address - Street 1:11 GARY WAY
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6244
Practice Address - Country:US
Practice Address - Phone:518-534-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304757164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY304757Medicaid