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NPI Code Detail

MEDICARE: ANDREA BUNDY NP

MEDICARE: ANDREA BUNDY NP
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
1363LF0000XFamily Nurse Practitioner209008694IL

General Provider Information

NPI Number : 1255639563
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA BUNDY NP
Provider Business Mailing Address
First Line : 14290 S LA GRANGE RD
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-2023
Country : US
Telephone Number : 844-755-8267
Fax Number : 773-834-8070
Provider Business Practice Location Address
First Line : 14290 S LA GRANGE RD
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-2023
Country : US
Telephone Number : 844-755-8267
Fax Number : 773-834-8070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2011
Last Update Date : 03/17/2018

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