Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704237867 | MI |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4704237867 | MI |
NPI | 1013497585 |
---|---|
Provider Name | Mrs. Julie Anne Bumpus X |
First Address | Dexter, MI 48130-1419 |
Second Address | Dexter, MI 48130-1419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 24/11/2021 |