Provider Demographics
NPI:1952949273
Name:BRIGHAM, LONNIE II
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:BRIGHAM
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 MIDVALE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1199
Mailing Address - Country:US
Mailing Address - Phone:608-290-3619
Mailing Address - Fax:
Practice Address - Street 1:3512 MIDVALE DR APT 8
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1199
Practice Address - Country:US
Practice Address - Phone:608-290-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care