Healthcare Provider Details

I. General information

NPI: 1649086224
Provider Name (Legal Business Name): SOLANGE BUMAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 N WALNUT ST UNIT 306
BATH PA
18014-1212
US

IV. Provider business mailing address

282 N WALNUT ST UNIT 306
BATH PA
18014-1212
US

V. Phone/Fax

Practice location:
  • Phone: 816-379-9254
  • Fax:
Mailing address:
  • Phone: 816-379-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN783009
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: