Provider Demographics
NPI:1790037448
Name:RUMPKE, BREEHAN (CPNP)
Entity Type:Individual
Prefix:
First Name:BREEHAN
Middle Name:
Last Name:RUMPKE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BOYMEL DR
Mailing Address - Street 2:PEDIATRIC ASSOCIATES OF FAIRFIELD, INC
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-874-9460
Mailing Address - Fax:513-874-5731
Practice Address - Street 1:5900 BOYMEL DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5526
Practice Address - Country:US
Practice Address - Phone:513-874-9460
Practice Address - Fax:513-874-5731
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20121906363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics