Healthcare Provider Details

I. General information

NPI: 1124961792
Provider Name (Legal Business Name): UMME MORIUM TUMPA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12831 HASBROOK DR
SAINT LOUIS MO
63146-3705
US

IV. Provider business mailing address

12831 HASBROOK DR
SAINT LOUIS MO
63146-3705
US

V. Phone/Fax

Practice location:
  • Phone: 601-818-9410
  • Fax:
Mailing address:
  • Phone: 601-818-9410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: