Provider Demographics
NPI:1871059477
Name:DRUMMOND, MICAH B (RN)
Entity type:Individual
Prefix:MS
First Name:MICAH
Middle Name:B
Last Name:DRUMMOND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S WHITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2264
Mailing Address - Country:US
Mailing Address - Phone:618-392-6241
Mailing Address - Fax:618-393-4078
Practice Address - Street 1:501 S WHITTLE AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2264
Practice Address - Country:US
Practice Address - Phone:618-392-6241
Practice Address - Fax:618-393-4078
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.432755163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse