Healthcare Provider Details

I. General information

NPI: 1962826784
Provider Name (Legal Business Name): LORI BUMPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD STE 4100
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

211 N WINDSONG LN
GREENWOOD IN
46142-7265
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-0889
  • Fax:
Mailing address:
  • Phone: 317-893-5171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28204297A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: