Healthcare Provider Details

I. General information

NPI: 1972225563
Provider Name (Legal Business Name): DEANNA KAY BUMP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PLAZA DR
MONTOURSVILLE PA
17754-2448
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-368-3321
  • Fax:
Mailing address:
  • Phone: 888-647-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP025155
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: