Individual
DANIELLE D BUNDRENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
315 E BROADWAY FL 4, LOUISVILLE, KY 40202-3700
(502) 629-2500
(502) 629-2055
Mailing address
PO BOX 776347, CHICAGO, IL 60677-6347
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3011198
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001077743
ANTHEM
KY
01
—
277495
SIHO
KY
01
—
300002098
MEDICAID
IN
05
—
300002098
—
IN
01
—
50125555
PASSPORT
KY
05
—
7100471000
—
KY
01
—
K222220
MEDICARE
KY
Enumeration date
03/20/2017
Last updated
11/21/2017
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