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NPI Code Detail

MEDICARE: MRS. BERNEAL E. BUNDY RN CRNFA

MEDICARE: MRS. BERNEAL E. BUNDY RN CRNFA
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
1163WM0705XMedical-Surgical Registered NurseRN00040561WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
230382OTHERL & I

General Provider Information

NPI Number : 1548258643
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BERNEAL E. BUNDY RN CRNFA
Provider Business Mailing Address
First Line : 1200 E COLUMBIA AVE
Second Line :
City : COLVILLE
State : WA
Zip : 99114-3354
Country : US
Telephone Number : 509-684-3701
Fax Number : 509-684-5817
Provider Business Practice Location Address
First Line : 1200 E COLUMBIA AVE
Second Line :
City : COLVILLE
State : WA
Zip : 99114-3354
Country : US
Telephone Number : 509-684-3701
Fax Number : 509-684-5817
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 07/08/2007

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