Healthcare Provider Details

I. General information

NPI: 1356289680
Provider Name (Legal Business Name): ELIZABETH PUNG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4226
US

IV. Provider business mailing address

9714 KELLY DR
LOVELAND OH
45140-5621
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-1000
  • Fax:
Mailing address:
  • Phone: 513-800-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-16811
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: