Provider Demographics
NPI:1063836583
Name:BUMPAS, NATALIE (ATC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:BUMPAS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-0840
Mailing Address - Country:US
Mailing Address - Phone:847-467-5549
Mailing Address - Fax:847-491-8865
Practice Address - Street 1:1501 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0840
Practice Address - Country:US
Practice Address - Phone:847-467-5549
Practice Address - Fax:847-491-8865
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.003530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist