Provider Demographics
NPI:1477104560
Name:BUNTIN, LUISA
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:BUNTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2516
Mailing Address - Country:US
Mailing Address - Phone:717-339-2875
Mailing Address - Fax:
Practice Address - Street 1:455 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2516
Practice Address - Country:US
Practice Address - Phone:717-339-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily