Provider Demographics
NPI:1578226072
Name:BUMPUS, CHRISTOPHER (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:BUMPUS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2984 US ROUTE 11 APT P64
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-9677
Mailing Address - Country:US
Mailing Address - Phone:315-466-3418
Mailing Address - Fax:
Practice Address - Street 1:217 EAST AVE
Practice Address - Street 2:
Practice Address - City:MINOA
Practice Address - State:NY
Practice Address - Zip Code:13116-1205
Practice Address - Country:US
Practice Address - Phone:315-656-7277
Practice Address - Fax:315-656-2517
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656672163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice