Healthcare Provider Details

I. General information

NPI: 1861349078
Provider Name (Legal Business Name): CARLI BUNDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W 10TH ST
MC COOK NE
69001-2911
US

IV. Provider business mailing address

817 CHIEF ST
BENKELMAN NE
69021-3052
US

V. Phone/Fax

Practice location:
  • Phone: 308-345-4223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3396
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: