Healthcare Provider Details

I. General information

NPI: 1518636182
Provider Name (Legal Business Name): BUNCENCIA KRISTINE BURNEKO RN, HN-BC, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 SCHLEY AVE STE A #68
BRADDOCK HEIGHTS MD
21714
US

IV. Provider business mailing address

4707 SCHLEY AVE STE A #68
BRADDOCK HEIGHTS MD
21714
US

V. Phone/Fax

Practice location:
  • Phone: 410-498-7676
  • Fax:
Mailing address:
  • Phone: 410-498-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR227158
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: