Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 27228 | TN |
NPI | 1003449398 |
---|---|
Provider Name | Mr. Nathaniel Levi Bump |
First Address | Olive Branch, MS 38654-9354 |
Second Address | Memphis, TN 38119-5218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2020 |
Last Update Date | 22/12/2020 |