Provider Demographics
NPI:1881344547
Name:RUNDBERG BUNNEY, ANNIKA GRACE
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:GRACE
Last Name:RUNDBERG BUNNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-0842
Mailing Address - Country:US
Mailing Address - Phone:425-681-3502
Mailing Address - Fax:
Practice Address - Street 1:2417 MCEWAN RD NW
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9616
Practice Address - Country:US
Practice Address - Phone:425-681-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator