Provider Demographics
NPI:1477677367
Name:BRUMBAUGH, CAROLYN D (RN, CRNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:D
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 PINEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693-8308
Mailing Address - Country:US
Mailing Address - Phone:814-312-8098
Mailing Address - Fax:
Practice Address - Street 1:8344 WOODBURY PIKE UNIT 101
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-8107
Practice Address - Country:US
Practice Address - Phone:814-205-4025
Practice Address - Fax:814-240-6632
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN5229646163W00000X
PASP011992363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102697854 0001Medicaid