Healthcare Provider Details

I. General information

NPI: 1043803497
Provider Name (Legal Business Name): ELIZABETH NEWCOMB BUNT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E MILLBROOK RD STE 130
RALEIGH NC
27609-4968
US

IV. Provider business mailing address

1616 E MILLBROOK RD STE 130
RALEIGH NC
27609-4968
US

V. Phone/Fax

Practice location:
  • Phone: 252-230-0452
  • Fax:
Mailing address:
  • Phone: 919-230-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014019
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: