Provider Demographics
NPI:1801070800
Name:BUNTING-PERRY, LISETTE KAREN (RN)
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:KAREN
Last Name:BUNTING-PERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LISETTE
Other - Middle Name:KAREN
Other - Last Name:BUNTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:110 BUNTING DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:PHILADELPHIA VAMC PADRECC #127
Practice Address - City:PHIALDELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-5934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN359030L163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience