Healthcare Provider Details

I. General information

NPI: 1891445771
Provider Name (Legal Business Name): LESLEY GAYLE BUNTING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST STE 605
SALISBURY MD
21804-6938
US

IV. Provider business mailing address

106 MILFORD ST STE 605
SALISBURY MD
21804-6938
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-2227
  • Fax:
Mailing address:
  • Phone: 410-334-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR215022
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: