Provider Demographics
NPI:1063243384
Name:BRUMLEY, TYTIANA MONQUIE
Entity type:Individual
Prefix:
First Name:TYTIANA
Middle Name:MONQUIE
Last Name:BRUMLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9227 N 75TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1120
Mailing Address - Country:US
Mailing Address - Phone:773-412-0102
Mailing Address - Fax:
Practice Address - Street 1:903 N 37TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3102
Practice Address - Country:US
Practice Address - Phone:773-412-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty