Provider Demographics
NPI:1366542433
Name:DRUMMOND, BRENDA LEA (MSN,CNP,CNS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEA
Last Name:DRUMMOND
Suffix:
Gender:F
Credentials:MSN,CNP,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 GARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1618
Mailing Address - Country:US
Mailing Address - Phone:419-290-6083
Mailing Address - Fax:
Practice Address - Street 1:3740 W SYLVANIA AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4461
Practice Address - Country:US
Practice Address - Phone:419-473-6670
Practice Address - Fax:419-473-9959
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.05725-NP363L00000X
MI4714236251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDRNP05922Medicare PIN