Provider Demographics
NPI:1699825901
Name:BUMGARDNER, CHRISTINE LORRAINE (APRN, CNS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LORRAINE
Last Name:BUMGARDNER
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 GULLETTE DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9795
Mailing Address - Country:US
Mailing Address - Phone:740-774-4283
Mailing Address - Fax:
Practice Address - Street 1:15802 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9701
Practice Address - Country:US
Practice Address - Phone:740-774-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 183506163WP0808X
OHNS-03462364SP0808X
OHCTP # RX. 03462364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health