Healthcare Provider Details

I. General information

NPI: 1346153186
Provider Name (Legal Business Name): JOSIE BUNGERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 MADISON ST NE
BLAINE MN
55434-3008
US

IV. Provider business mailing address

11760 MADISON ST NE
BLAINE MN
55434-3008
US

V. Phone/Fax

Practice location:
  • Phone: 763-477-8095
  • Fax:
Mailing address:
  • Phone: 763-477-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2485760
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: