Provider Demographics
NPI:1548954738
Name:MCCUMBERS, BRANDI L (LPN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:MCCUMBERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CASINO DR SUITE 104
Mailing Address - Street 2:
Mailing Address - City:ANMORE
Mailing Address - State:WV
Mailing Address - Zip Code:26323
Mailing Address - Country:US
Mailing Address - Phone:304-622-1684
Mailing Address - Fax:304-622-0810
Practice Address - Street 1:67 CASINO DRIVE SIUTE 104
Practice Address - Street 2:
Practice Address - City:ANMORE
Practice Address - State:WV
Practice Address - Zip Code:26323
Practice Address - Country:US
Practice Address - Phone:304-622-1684
Practice Address - Fax:304-622-0810
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25436164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse