Provider Demographics
NPI:1063575868
Name:BRUMMERSTEDT, LORI ANN (ANP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:BRUMMERSTEDT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:TINDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:5216 N. BROADWAY ST.
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918
Mailing Address - Country:US
Mailing Address - Phone:865-687-8746
Mailing Address - Fax:865-687-8444
Practice Address - Street 1:5216 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2344
Practice Address - Country:US
Practice Address - Phone:865-687-8746
Practice Address - Fax:865-687-8444
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health