Provider Demographics
NPI:1245308006
Name:BRUMMIT, PAMELA SUE (RD LD)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:BRUMMIT
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 MONTICELLO PL
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1353
Mailing Address - Country:US
Mailing Address - Phone:918-645-5775
Mailing Address - Fax:580-242-4412
Practice Address - Street 1:4418 MONTICELLO PL
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1353
Practice Address - Country:US
Practice Address - Phone:918-645-5775
Practice Address - Fax:580-242-4412
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered