Provider Demographics
NPI:1811425572
Name:BUNDY, MADELINE (MPH, CNM, WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:
Last Name:BUNDY
Suffix:
Gender:F
Credentials:MPH, CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ELECTRIC RD STE 1030
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7474
Mailing Address - Country:US
Mailing Address - Phone:540-774-6000
Mailing Address - Fax:
Practice Address - Street 1:1900 ELECTRIC RD STE 1030
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:540-774-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC879367A00000X
GA367A00000X
VA0024181291367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024181291Medicaid