Provider Demographics
NPI:1528369451
Name:BUMGARDNER, MICHELLE MARY (FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARY
Last Name:BUMGARDNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARY
Other - Last Name:MCNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:50 E WYLIE AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2059
Mailing Address - Country:US
Mailing Address - Phone:724-221-9712
Mailing Address - Fax:
Practice Address - Street 1:50 E WYLIE AVE STE 123
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2059
Practice Address - Country:US
Practice Address - Phone:724-221-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily