Provider Demographics
NPI:1275197188
Name:BUMPHUS, ANGEL RENEE
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:RENEE
Last Name:BUMPHUS
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 1:10695 COYOTE RUN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-8314
Mailing Address - Country:US
Mailing Address - Phone:317-698-9128
Mailing Address - Fax:
Practice Address - Street 1:9660 COMMERCE DR STE 611A
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7640
Practice Address - Country:US
Practice Address - Phone:317-698-9128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health