Provider Demographics
NPI:1689225658
Name:BUNGERT, BEVERLEY CATHERINE
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:CATHERINE
Last Name:BUNGERT
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 1:1717 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4608
Mailing Address - Country:US
Mailing Address - Phone:125-347-4721
Mailing Address - Fax:
Practice Address - Street 1:1717 E 42ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4608
Practice Address - Country:US
Practice Address - Phone:125-347-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider