Provider Demographics
NPI:1659093763
Name:BUNTING, ZIVAGO Z I (DNP)
Entity Type:Individual
Prefix:
First Name:ZIVAGO
Middle Name:Z
Last Name:BUNTING
Suffix:I
Gender:M
Credentials:DNP
Other - Prefix:DR
Other - First Name:ZIVAGO
Other - Middle Name:
Other - Last Name:BUNTING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APRN, PMHNP-BC
Mailing Address - Street 1:8775 CENTRE PARK DR STE M613
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2177
Mailing Address - Country:US
Mailing Address - Phone:240-444-6110
Mailing Address - Fax:888-687-0848
Practice Address - Street 1:8775 CENTRE PARK DR STE M613
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2177
Practice Address - Country:US
Practice Address - Phone:240-444-6110
Practice Address - Fax:888-687-0848
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR150087363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health