Provider Demographics
NPI:1609384908
Name:CHUMO, ELIJAH KIMUTAI (NP)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:KIMUTAI
Last Name:CHUMO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-3603
Mailing Address - Country:US
Mailing Address - Phone:585-415-5057
Mailing Address - Fax:
Practice Address - Street 1:6007 PALOMINO DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-3603
Practice Address - Country:US
Practice Address - Phone:585-415-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-21
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN623561163W00000X
PASP026878363LA2100X, 363LG0600X
PASP018364363LF0000X
NYF342461-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty