Healthcare Provider Details

I. General information

NPI: 1538304464
Provider Name (Legal Business Name): KATY ANNE BUMA LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14313 NE 20TH AVE SUITE A112
VANCOUVER WA
98686-1487
US

IV. Provider business mailing address

16407 NE UNION RD
RIDGEFIELD WA
98642-5614
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-9440
  • Fax:
Mailing address:
  • Phone: 360-300-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00024799
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: