Provider Demographics
NPI:1043867732
Name:BUMGARNER, LISA SIGMON
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SIGMON
Last Name:BUMGARNER
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 1:5370 MILLER MILL RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8456
Mailing Address - Country:US
Mailing Address - Phone:828-302-4589
Mailing Address - Fax:
Practice Address - Street 1:5370 MILLER MILL RD
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8456
Practice Address - Country:US
Practice Address - Phone:828-302-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider