Provider Demographics
NPI:1124020243
Name:KLUMPH, MARY E (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:KLUMPH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:777 FLOWER ST
Mailing Address - Street 2:STE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3000
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-242-8761
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:STE 200
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1254
Practice Address - Country:US
Practice Address - Phone:818-365-8553
Practice Address - Fax:818-365-4524
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP6839363L00000X
CARN268367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN268367Medicaid
CAS57576Medicare UPIN
CARN268367Medicaid