Provider Demographics
NPI:1043542061
Name:BUNTA, ADRIAN ALEXANDER (NP-C)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:ALEXANDER
Last Name:BUNTA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:DR
Other - First Name:ADRIAN
Other - Middle Name:A
Other - Last Name:BUNTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:13241 W JACOBSON DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5394
Mailing Address - Country:US
Mailing Address - Phone:623-734-0167
Mailing Address - Fax:
Practice Address - Street 1:13241 W JACOBSON DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5394
Practice Address - Country:US
Practice Address - Phone:623-734-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12461101YM0800X
AZRN169699163W00000X
AZ220199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ220199OtherARIZONA STATE BOARD OF NURSING
F11180888OtherAANPCB
AZLPC-12461OtherAZBBHE