MEDICARE: KATY ANNE BUMA LMP

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	174400000X	Specialist	MA00024799	WA

General Provider Information

NPI Number	:	1538304464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY ANNE BUMA LMP

Provider Business Mailing Address
First Line	:	16407 NE UNION RD
Second Line	:
City	:	RIDGEFIELD
State	:	WA
Zip	:	98642-5614
Country	:	US
Telephone Number	:	360-300-6129
Fax Number	:

Provider Business Practice Location Address
First Line	:	14313 NE 20TH AVE
Second Line	:	SUITE A112
City	:	VANCOUVER
State	:	WA
Zip	:	98686-1487
Country	:	US
Telephone Number	:	360-574-9440
Fax Number	:

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

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	12/05/2008

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Directions to “ KATY ANNE BUMA LMP” Practice Location

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