Provider Demographics
NPI:1689990046
Name:BUNDY, BETHANY LOU (LMT, CD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LOU
Last Name:BUNDY
Suffix:
Gender:F
Credentials:LMT, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OLMSTEAD LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-3910
Mailing Address - Country:US
Mailing Address - Phone:865-481-4843
Mailing Address - Fax:
Practice Address - Street 1:107 OLMSTEAD LN
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-3910
Practice Address - Country:US
Practice Address - Phone:865-481-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula