MEDICARE: ASHLEY NICHOLE BUMGARDNER RN

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	163W00000X	Registered Nurse	285505	NC

General Provider Information

NPI Number	:	1841894250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICHOLE BUMGARDNER RN

Provider Business Mailing Address
First Line	:	2751 BRIDGEPORT DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 S WESTGATE DR STE H
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1632
Country	:	US
Telephone Number	:	336-285-7915
Fax Number	:

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

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/25/2020

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