Healthcare Provider Details

I. General information

NPI: 1033867700
Provider Name (Legal Business Name): MS. EMILY ANN BUMPUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2022
Last Update Date: 03/12/2022
Certification Date: 03/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

IV. Provider business mailing address

550 CURVE ST
BRIDGEWATER MA
02324-3425
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: