Provider Demographics
NPI:1134484504
Name:BUNDICK, ROBIN A (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:BUNDICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:R
Other - Last Name:ARDOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-3755
Mailing Address - Fax:504-842-2036
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3755
Practice Address - Fax:504-842-2036
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06900367500000X
LARN102479367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2304615Medicaid
MS00186794Medicaid
LA3D2617061Medicare PIN