Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 38256 | NC |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 38256 | NC |
NPI | 1619914215 |
---|---|
Provider Name | Jane Katherine Bernhardt Brummer |
First Address | Salem, VA 24153-6404 |
Second Address | Salem, VA 24153-6404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 10/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8919322 | (05) | NC |
E11218 | (02) |