Provider Demographics
NPI:1184901563
Name:MUMBAUER, AMORY JEAN (PA)
Entity type:Individual
Prefix:
First Name:AMORY
Middle Name:JEAN
Last Name:MUMBAUER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMORY
Other - Middle Name:JEAN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1146 S. CEDAR CREST BLVD.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1146 S. CEDAR CREST BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7938
Practice Address - Country:US
Practice Address - Phone:610-366-9000
Practice Address - Fax:610-366-9229
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055298363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical