MEDICARE: SOPHIE LAVONE BUNCH

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	163W00000X	Registered Nurse	2020007954	MO

General Provider Information

NPI Number	:	1609525211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE LAVONE BUNCH

Provider Business Mailing Address
First Line	:	1328 NE GRAND AVE
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-8441
Country	:	US
Telephone Number	:	620-755-2088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 NE GRAND AVE
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-8441
Country	:	US
Telephone Number	:	620-755-2088
Fax Number	:

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

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	03/21/2022

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Directions to “ SOPHIE LAVONE BUNCH ” Practice Location

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