Provider Demographics
NPI:1972538734
Name:BUNO, ELIZABETH R (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:BUNO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:R
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:107 WEEKS DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-3933
Mailing Address - Country:US
Mailing Address - Phone:336-598-5480
Mailing Address - Fax:336-598-5482
Practice Address - Street 1:107 WEEKS DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-3933
Practice Address - Country:US
Practice Address - Phone:336-598-5480
Practice Address - Fax:336-598-5482
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ32325Medicare UPIN
NC2762412CMedicare ID - Type UnspecifiedMEDICARE INDIV
NCNC4890AMedicare PIN