Provider Demographics
NPI:1134416985
Name:BUNN, ANDREW W (RN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:BUNN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:O
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:473 W OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2119
Mailing Address - Country:US
Mailing Address - Phone:414-870-2036
Mailing Address - Fax:
Practice Address - Street 1:473 W OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2119
Practice Address - Country:US
Practice Address - Phone:414-870-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178603-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health