Provider Demographics
NPI:1730312497
Name:BUNDUKAMARA, CRISTI (APN)
Entity Type:Individual
Prefix:DR
First Name:CRISTI
Middle Name:
Last Name:BUNDUKAMARA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SINTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5085
Mailing Address - Country:US
Mailing Address - Phone:719-493-9555
Mailing Address - Fax:
Practice Address - Street 1:3720 SINTON RD STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5085
Practice Address - Country:US
Practice Address - Phone:719-493-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2931032364SP0810X
COAPN.0990951-NP363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner