Provider Demographics
NPI:1942533922
Name:BRUBACHER, MARCY S (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:S
Last Name:BRUBACHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:S
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 E RANDALL ST
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-8806
Mailing Address - Country:US
Mailing Address - Phone:620-327-2440
Mailing Address - Fax:620-327-2062
Practice Address - Street 1:705 E RANDALL ST
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-8806
Practice Address - Country:US
Practice Address - Phone:620-327-2440
Practice Address - Fax:620-327-2062
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST02569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant