Provider Demographics
NPI:1003651480
Name:BUMPERS, STEPHANIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BUMPERS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-0350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:807 BETHLEHEM RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-6109
Practice Address - Country:US
Practice Address - Phone:251-725-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131562163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty