Healthcare Provider Details

I. General information

NPI: 1457621401
Provider Name (Legal Business Name): DEBORAH D BUMP-BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CLEVELAND DR. TUSCARORA ELEMENTARY SCHOOL
ADDISON NY
14801
US

IV. Provider business mailing address

7 CLEVELAND DR
ADDISON NY
14801-1324
US

V. Phone/Fax

Practice location:
  • Phone: 607-359-2261
  • Fax: 607-359-4507
Mailing address:
  • Phone: 607-359-2261
  • Fax: 607-359-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number423530-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: