Provider Demographics
NPI:1972258812
Name:BUMFORD, SHAUNA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:BUMFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FOUNDRY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5421
Mailing Address - Country:US
Mailing Address - Phone:603-228-0071
Mailing Address - Fax:603-227-7535
Practice Address - Street 1:18 FOUNDRY ST STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5421
Practice Address - Country:US
Practice Address - Phone:603-228-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH061379-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily