Provider Demographics
NPI:1538513619
Name:BUNZ, MALLORY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:BUNZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:NAKAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2664 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102
Mailing Address - Country:US
Mailing Address - Phone:406-969-6622
Mailing Address - Fax:
Practice Address - Street 1:2664 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-969-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT182023163W00000X
CA95004099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse