MEDICARE: DR. ADRIAN ALEXANDER BUNTA NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-12461	AZ
2	163W00000X	Registered Nurse	RN169699	AZ
3	363LF0000X	Family Nurse Practitioner	220199	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220199	OTHER	AZ	ARIZONA STATE BOARD OF NURSING
2	F11180888	OTHER		AANPCB
3	LPC-12461	OTHER	AZ	AZBBHE

General Provider Information

NPI Number	:	1043542061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIAN ALEXANDER BUNTA NP-C

Provider Business Mailing Address
First Line	:	13241 W JACOBSON DR
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-5394
Country	:	US
Telephone Number	:	623-734-0167
Fax Number	:

Provider Business Practice Location Address
First Line	:	13241 W JACOBSON DR
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-5394
Country	:	US
Telephone Number	:	623-734-0167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	07/20/2021

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