Healthcare Provider Details

I. General information

NPI: 1124490594
Provider Name (Legal Business Name): NICOLE L BRUMAGE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE L SNYDER CRNA

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-8132
US

IV. Provider business mailing address

500 W SUPERIOR ST UNIT 2009
CHICAGO IL
60654-8132
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5700
  • Fax:
Mailing address:
  • Phone: 724-544-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.435683
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209013912
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: