Provider Demographics
NPI:1992825913
Name:OLUBUMMO, CATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:OLUBUMMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SCOUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2544
Mailing Address - Country:US
Mailing Address - Phone:914-490-6199
Mailing Address - Fax:845-519-6502
Practice Address - Street 1:110 SCOUT HILL RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-2544
Practice Address - Country:US
Practice Address - Phone:914-490-6199
Practice Address - Fax:845-519-6502
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1992825913OtherNPI