Provider Demographics
NPI:1689928673
Name:BUNTING, LESLIE ELLEN (ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ELLEN
Last Name:BUNTING
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ELLEN
Other - Last Name:KILB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1626 DEXTER LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8658
Mailing Address - Country:US
Mailing Address - Phone:847-772-3723
Mailing Address - Fax:
Practice Address - Street 1:9339 MEDICAL PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9104
Practice Address - Country:US
Practice Address - Phone:847-797-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily