Healthcare Provider Details

I. General information

NPI: 1659097293
Provider Name (Legal Business Name): APRIL ANN BUMANLAG MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BARNES BLVD
JOINT BASE LEWIS MCCHORD WA
98438-1304
US

IV. Provider business mailing address

17615 SW MEADOWBROOK WAY
BEAVERTON OR
97078-1742
US

V. Phone/Fax

Practice location:
  • Phone: 253-967-1110
  • Fax:
Mailing address:
  • Phone: 503-516-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-10226990
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: