Provider Demographics
NPI:1760706329
Name:BRUMMOND, JAMIE MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MARIE
Last Name:BRUMMOND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 S MUCKEY ST
Mailing Address - Street 2:BURGESS FAMILY CLINICS
Mailing Address - City:MAPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51034-1055
Mailing Address - Country:US
Mailing Address - Phone:712-882-2234
Mailing Address - Fax:712-822-2605
Practice Address - Street 1:513 S MUCKEY ST
Practice Address - Street 2:BURGESS FAMILY CLINICS
Practice Address - City:MAPLETON
Practice Address - State:IA
Practice Address - Zip Code:51034-1055
Practice Address - Country:US
Practice Address - Phone:712-882-2234
Practice Address - Fax:712-822-2605
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-118308363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAGROUP057570Medicaid