Provider Demographics
NPI:1164526646
Name:BUNGER, KATHERINE N (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:N
Last Name:BUNGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:N
Other - Last Name:NETZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:67 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 DIVISION ST FL 1
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1326
Practice Address - Country:US
Practice Address - Phone:203-732-1257
Practice Address - Fax:203-732-2470
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002954363LA2200X
CT2954363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ06989Medicare UPIN