Provider Demographics
NPI:1467452433
Name:BUMANN, KAREN D (PA-C, RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:BUMANN
Suffix:
Gender:F
Credentials:PA-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:208 S MAIN AVE
Mailing Address - City:HOWARD
Mailing Address - State:SD
Mailing Address - Zip Code:57349-0099
Mailing Address - Country:US
Mailing Address - Phone:605-772-4574
Mailing Address - Fax:
Practice Address - Street 1:709 4TH ST SE
Practice Address - Street 2:
Practice Address - City:LAKE PRESTON
Practice Address - State:SD
Practice Address - Zip Code:57249-2116
Practice Address - Country:US
Practice Address - Phone:605-847-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4406Medicare ID - Type Unspecified
SDR02600Medicare UPIN