Healthcare Provider Details

I. General information

NPI: 1487625968
Provider Name (Legal Business Name): DEANNA BRUMBAUGH CPHT, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/25/2020
Certification Date: 01/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 1ST STREET A
MOLINE IL
61265-7728
US

IV. Provider business mailing address

915 27TH AVE
ROCK ISLAND IL
61201-5229
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-9320
  • Fax: 309-797-0199
Mailing address:
  • Phone: 309-912-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049-129846
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041368945
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: