Healthcare Provider Details

I. General information

NPI: 1801889514
Provider Name (Legal Business Name): RICHARD EDWARD BUNTON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2005
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WILDFLOWER DR.
WILKES BARRE PA
18702-3813
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-8843
  • Fax: 570-808-8844
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP002132C
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberVP002132C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: