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General NPI Number Information
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NPI Number | 1033444690
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Entity Type | Individual
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Provider Name | ELAINE YOUNG BUNDY CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/14/2009
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Last Update Date | 12/20/2015
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Provider Practice Location Address
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Address Line | 12150 ANNAPOLIS RD SUITE 108
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City | GLENN DALE
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State | MD
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Zip | 20769-9183
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Country | US
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Telephone | 301-860-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 CHESHIRE LN
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City | BEL AIR
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State | MD
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Zip | 21014-2552
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Country | US
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Telephone | 410-652-3224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R057484
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License Number State | MD
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