Healthcare Provider Details

I. General information

NPI: 1407032618
Provider Name (Legal Business Name): SHAUNTRICE BUMPERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/02/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JENNINGS STATION RD
SAINT LOUIS MO
63121-3323
US

IV. Provider business mailing address

2845 VETERAN MEMORIAL PKWY
SAINT CHARLES MO
63301
US

V. Phone/Fax

Practice location:
  • Phone: 636-485-1173
  • Fax:
Mailing address:
  • Phone: 636-485-1173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2018030437
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: