Healthcare Provider Details

I. General information

NPI: 1114693181
Provider Name (Legal Business Name): GEORGE BRUMMELL PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N COUNTY ROAD 2050 E
CARTHAGE IL
62321-3551
US

IV. Provider business mailing address

1450 N COUNTY ROAD 2050 E
CARTHAGE IL
62321-3551
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-6888
  • Fax:
Mailing address:
  • Phone: 217-357-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberAP61194142
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209026348
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: