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General NPI Number Information
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NPI Number | 1063575868
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Entity Type | Individual
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Provider Name | LORI ANN BRUMMERSTEDT ANP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 5216 N BROADWAY ST
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City | KNOXVILLE
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State | TN
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Zip | 37918-2344
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Country | US
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Telephone | 865-687-8746
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Fax | 865-687-8444
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Provider Business Mailing Address
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Address Line | 5216 N. BROADWAY ST.
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City | KNOXVILLE
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State | TN
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Zip | 37918
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Country | US
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Telephone | 865-687-8746
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Fax | 865-687-8444
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 12300
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License Number State | TN
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