MEDICARE: MS. CYNTHIA JUNE CLARK-BUMGARNER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209025457	IL
2	367500000X	Certified Registered Nurse Anesthetist	2022005931	MO

General Provider Information

NPI Number	:	1376114017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA JUNE CLARK-BUMGARNER CRNA

Provider Business Mailing Address
First Line	:	251 E HURON ST STE 5-704
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:	312-926-8369
Fax Number	:	312-926-8341

Provider Business Practice Location Address
First Line	:	251 E HURON ST STE 5-704
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:	312-926-8369
Fax Number	:	312-926-8341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2021
Last Update Date	:	01/06/2026

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