Provider Demographics
NPI:1558136267
Name:BUNDANG, ROSS ANN (RN)
Entity Type:Individual
Prefix:
First Name:ROSS ANN
Middle Name:
Last Name:BUNDANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8219 292ND ST S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-8769
Mailing Address - Country:US
Mailing Address - Phone:253-223-9326
Mailing Address - Fax:
Practice Address - Street 1:8219 292ND ST S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580-8769
Practice Address - Country:US
Practice Address - Phone:253-223-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60886655163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse