Provider Demographics
NPI:1831153121
Name:BRUBAKER, NANCY L (MSN, C-FNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:MSN, C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-477-3185
Mailing Address - Fax:757-579-8555
Practice Address - Street 1:120 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT JACKSON
Practice Address - State:VA
Practice Address - Zip Code:22842-9417
Practice Address - Country:US
Practice Address - Phone:540-477-3185
Practice Address - Fax:757-579-8555
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024104848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7790848Medicaid
500020171OtherRAILROAD MEDICARE
S48351Medicare UPIN
WV7102147000OtherWEST VIRGINIA MEDICAID
500000889Medicare ID - Type Unspecified
VA7790848Medicaid