Provider Demographics
NPI:1316936230
Name:GUMM, NANCY ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELAINE
Last Name:GUMM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5385
Mailing Address - Country:US
Mailing Address - Phone:724-837-3111
Mailing Address - Fax:724-837-3022
Practice Address - Street 1:1275 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5385
Practice Address - Country:US
Practice Address - Phone:724-837-3111
Practice Address - Fax:724-837-3022
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000810L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant