Individual
EMILY JEAN BUNDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3301 TURNBERRY DR, JANESVILLE, WI 53548-9174
(608) 305-0084
Mailing address
3301 TURNBERRY DR, JANESVILLE, WI 53548-9174
(608) 305-0084
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35040500
MEDICAID PROVIDER NUMBER
WI
Enumeration date
12/26/2007
Last updated
12/26/2007
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