Basic Information
| Provider Information | |||||||||
| NPI: | 1497942395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUMMELHOFF | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MECHER | ||||||||
| OtherFirstName: | BROOKE | ||||||||
| OtherMiddleName: | M. | ||||||||
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| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1400 W ICE LAKE RD | ||||||||
| Address2: | |||||||||
| City: | IRON RIVER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499359526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9062656121 | ||||||||
| FaxNumber: | 9062654245 | ||||||||
| Practice Location | |||||||||
| Address1: | 927 RIVERSIDE PLZ | ||||||||
| Address2: | |||||||||
| City: | IRON RIVER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499351529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9062652165 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 10/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 085-002439 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.