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General NPI Number Information
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NPI Number | 1316483092
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Entity Type | Individual
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Provider Name | LYDIA BUNDICK RN
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Gender | Female
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 2929 CALDER ST SUITE 100
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City | BEAUMONT
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State | TX
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Zip | 77702-1845
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Country | US
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Telephone | 409-833-9797
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Fax | 409-654-6921
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Provider Business Mailing Address
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Address Line | 2929 CALDER ST SUITE 100
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City | BEAUMONT
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State | TX
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Zip | 77702-1845
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Country | US
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Telephone | 409-833-9797
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Fax | 409-654-6886
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 804089
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP133119
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP133119
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License Number State | TX
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