Provider Demographics
NPI:1629172267
Name:BUNCE, NANCY LA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LA
Last Name:BUNCE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 TEAL DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7227
Mailing Address - Country:US
Mailing Address - Phone:410-820-5945
Mailing Address - Fax:410-820-9642
Practice Address - Street 1:8221 TEAL DR
Practice Address - Street 2:SUITE 301
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7227
Practice Address - Country:US
Practice Address - Phone:410-820-5945
Practice Address - Fax:410-820-9642
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000387363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100820000Medicaid
MDR033948OtherREGISTERED NURSE
MDAC000387OtherNURSE PRACTITIONER
MD313MP150Medicare PIN