Basic Information
| Provider Information | |||||||||
| NPI: | 1831153121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUBAKER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MSN, C-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1430 | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228031430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404773185 | ||||||||
| FaxNumber: | 7575798555 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT JACKSON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228429417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404773185 | ||||||||
| FaxNumber: | 7575798555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 01/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024104848 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7790848 | 05 | VA | MEDICAID |