Healthcare Provider Details

I. General information

NPI: 1821907296
Provider Name (Legal Business Name): SUMMER BUNTING
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S DIAMOND ST.
DEMING NM
88030
US

IV. Provider business mailing address

1000 S DIAMOND ST.
DEMING NM
88030
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-2047
  • Fax:
Mailing address:
  • Phone: 575-546-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB20250068
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB20250068
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: