Provider Demographics
NPI:1417124447
Name:BUNT, KATHREN A (L AC)
Entity Type:Individual
Prefix:MS
First Name:KATHREN
Middle Name:A
Last Name:BUNT
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 ABINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-2759
Mailing Address - Country:US
Mailing Address - Phone:260-485-5309
Mailing Address - Fax:
Practice Address - Street 1:7315 ABINGTON DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-2759
Practice Address - Country:US
Practice Address - Phone:260-485-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000093A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist