Provider Demographics
NPI:1710425350
Name:THURMAN, BRIA
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:THURMAN
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 1:946 WIGWAM HOLLOW RD
Mailing Address - Street 2:APT 1
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-4134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:946 WIGWAM HOLLOW RD
Practice Address - Street 2:APT 1
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-4134
Practice Address - Country:US
Practice Address - Phone:309-318-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program