Provider Demographics
NPI:1003898776
Name:BUNTING, TERRI L (ARNP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:BUNTING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-440-0304
Mailing Address - Fax:515-440-4623
Practice Address - Street 1:555 S 51ST ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-6967
Practice Address - Country:US
Practice Address - Phone:515-440-0304
Practice Address - Fax:515-440-4623
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA060979207RC0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419507Medicaid
IAI4307Medicare ID - Type Unspecified
IA719260405Medicare PIN
IAP40380Medicare UPIN
IAI8659006Medicare PIN