Provider Demographics
NPI:1245530047
Name:RUMERY, BRENDA (MT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:RUMERY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 ARCADIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5404
Mailing Address - Country:US
Mailing Address - Phone:207-939-0855
Mailing Address - Fax:207-839-2197
Practice Address - Street 1:222 AUBURN ST STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6005
Practice Address - Country:US
Practice Address - Phone:207-939-0855
Practice Address - Fax:207-839-2197
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist