Healthcare Provider Details

I. General information

NPI: 1659093763
Provider Name (Legal Business Name): ZIVAGO Z BUNTING DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ZIVAGO BUNTING DNP, APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR STE 500
LAUREL MD
20708-4245
US

IV. Provider business mailing address

14502 GREENVIEW DR STE 500
LAUREL MD
20708-4245
US

V. Phone/Fax

Practice location:
  • Phone: 240-444-6110
  • Fax: 949-695-3130
Mailing address:
  • Phone: 240-444-6110
  • Fax: 949-695-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR150087
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: