Individual
BETHANY J. MUMBOWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2200 WABASH AVE, SPRINGFIELD, IL 62704-5352
(217) 528-7541
(217) 528-8962
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
(217) 528-8962
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003839
IL
363A00000X
Physician Assistant
10001491A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01180284
MEDICARE RAILROAD PTAN
IN
Enumeration date
09/07/2010
Last updated
06/18/2020
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