Healthcare Provider Details

I. General information

NPI: 1013497585
Provider Name (Legal Business Name): JULIE ANNE BUMPUS X FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 01/28/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 ANN ARBOR STREET SUITE D
DEXTER MI
48130-1419
US

IV. Provider business mailing address

4848 GREGORY RD STE A
DEXTER MI
48130-9628
US

V. Phone/Fax

Practice location:
  • Phone: 734-730-8445
  • Fax:
Mailing address:
  • Phone: 734-726-5421
  • Fax: 949-543-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704237867
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704237867
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: