MEDICARE: MR. JARED THOMAS BUNDE RN, PHN

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	163WC1500X	Community Health Registered Nurse	545142	CA
2	163W00000X	Registered Nurse	95029154	CA

General Provider Information

NPI Number	:	1629425004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARED THOMAS BUNDE RN, PHN

Provider Business Mailing Address
First Line	:	1101 B GALE WILSON BLVD
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3700
Country	:	US
Telephone Number	:	706-646-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 B GALE WILSON BLVD
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3700
Country	:	US
Telephone Number	:	707-646-5000
Fax Number	:

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/22/2026

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