Healthcare Provider Details

I. General information

NPI: 1609546779
Provider Name (Legal Business Name): BRIANNA DANIELLE BUMBAUGH MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 N HOLLAND SYLVANIA RD STE 220
TOLEDO OH
43623-3537
US

IV. Provider business mailing address

18778 W RIVER RD
BOWLING GREEN OH
43402-9118
US

V. Phone/Fax

Practice location:
  • Phone: 419-517-7665
  • Fax:
Mailing address:
  • Phone: 419-206-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029464
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: