Provider Demographics
NPI:1841292349
Name:BRUBAKER, BARBARA ANN (APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 E STATE ROAD 2
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-9607
Mailing Address - Country:US
Mailing Address - Phone:219-462-8337
Mailing Address - Fax:
Practice Address - Street 1:COUNTY ROAD 1100 WEST
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46391-9706
Practice Address - Country:US
Practice Address - Phone:219-785-2511
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000733A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS91111Medicare ID - Type Unspecified