Healthcare Provider Details

I. General information

NPI: 1629813555
Provider Name (Legal Business Name): SHEENA R BRUMFIELD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 S FREMONT AVE FL 2
SPRINGFIELD MO
65804-2206
US

IV. Provider business mailing address

2055 S FREMONT AVE FL 2
SPRINGFIELD MO
65804-2206
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-8099
  • Fax: 417-820-8093
Mailing address:
  • Phone: 417-820-8099
  • Fax: 417-820-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTBD
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: