Healthcare Provider Details

I. General information

NPI: 1841894250
Provider Name (Legal Business Name): ASHLEY NICHOLE BUMGARDNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S WESTGATE DR STE H
GREENSBORO NC
27407-1632
US

IV. Provider business mailing address

2751 BRIDGEPORT DR
WINSTON SALEM NC
27103-5448
US

V. Phone/Fax

Practice location:
  • Phone: 336-285-7915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number285505
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: