Provider Demographics
NPI:1376638866
Name:BUNCH, AMANDA CHAMPION (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHAMPION
Last Name:BUNCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3571
Mailing Address - Country:US
Mailing Address - Phone:252-623-2116
Mailing Address - Fax:252-833-0230
Practice Address - Street 1:1203 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3571
Practice Address - Country:US
Practice Address - Phone:252-623-2116
Practice Address - Fax:252-833-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201701363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99168Medicare UPIN
NCP99168Medicare UPIN