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General NPI Number Information
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NPI Number | 1659097293
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Entity Type | Individual
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Provider Name | APRIL ANN BUMANLAG MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 530 BARNES BLVD
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98438-1304
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Country | US
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Telephone | 253-967-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 17615 SW MEADOWBROOK WAY
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City | BEAVERTON
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State | OR
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Zip | 97078-1742
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Country | US
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Telephone | 503-516-3218
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-AT-10226990
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License Number State | OR
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