Healthcare Provider Details

I. General information

NPI: 1063575868
Provider Name (Legal Business Name): LORI ANN BRUMMERSTEDT ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI ANN TINDELL ANP

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5216 N BROADWAY ST
KNOXVILLE TN
37918-2344
US

IV. Provider business mailing address

5216 N. BROADWAY ST.
KNOXVILLE TN
37918
US

V. Phone/Fax

Practice location:
  • Phone: 865-687-8746
  • Fax: 865-687-8444
Mailing address:
  • Phone: 865-687-8746
  • Fax: 865-687-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12300
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: