Provider Demographics
NPI:1043388184
Name:BUNZ, TAMARA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:BUNZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 S 67TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-9236
Mailing Address - Country:US
Mailing Address - Phone:402-421-7663
Mailing Address - Fax:
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-466-3355
Practice Address - Fax:402-466-3410
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1017363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE75306398600Medicaid
NE278245Medicare ID - Type Unspecified