Healthcare Provider Details

I. General information

NPI: 1992528343
Provider Name (Legal Business Name): AMANDA BUMAGNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA OEY BUMAGNY ORELLANA

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E YESLER WAY UNIT 839
SEATTLE WA
98122-6535
US

IV. Provider business mailing address

1000 E YESLER WAY UNIT 839
SEATTLE WA
98122-6535
US

V. Phone/Fax

Practice location:
  • Phone: 817-403-0193
  • Fax:
Mailing address:
  • Phone: 817-403-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: