Provider Demographics
NPI:1851032411
Name:BRUSH, CHRISTOPHER SHAUNE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHAUNE
Last Name:BRUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SOLON CT
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-1050
Mailing Address - Country:US
Mailing Address - Phone:681-265-1215
Mailing Address - Fax:
Practice Address - Street 1:403 SOLON CT
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-1050
Practice Address - Country:US
Practice Address - Phone:681-265-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant