Provider Demographics
NPI:1497822399
Name:BUMGARNER, MARILYN
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
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 1:126 GREEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4015
Mailing Address - Country:US
Mailing Address - Phone:434-237-6186
Mailing Address - Fax:434-239-6807
Practice Address - Street 1:1212 MCCONVILLE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4536
Practice Address - Country:US
Practice Address - Phone:434-237-8886
Practice Address - Fax:434-239-6807
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024078254363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics