Individual
SARA ANN BUNTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, PNP-PC
Contact information
Practice address
13600 E 86TH ST N STE 200, OWASSO, OK 74055-8732
(918) 609-5700
Mailing address
12324 E 86TH ST N # 472, OWASSO, OK 74055-2543
(918) 605-8609
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
83204
OK
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
83204
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83204
STATE LICENSE
OK
Enumeration date
09/25/2012
Last updated
05/02/2024
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