Provider Demographics
NPI:1083626972
Name:PUMPELLY, MIRIAM EDITH KURTZ
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:EDITH KURTZ
Last Name:PUMPELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:EDITH KURTZ
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1670 FISHINGER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1420
Mailing Address - Country:US
Mailing Address - Phone:614-450-0077
Mailing Address - Fax:509-459-3355
Practice Address - Street 1:1670 FISHINGER RD STE 100
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-1420
Practice Address - Country:US
Practice Address - Phone:614-450-0077
Practice Address - Fax:509-459-3355
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH311030163W00000X
WARN00166818163W00000X
WAPENDING363LF0000X
OHCNP.022031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse