Individual
LISA K BUNCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1633 N CAPITOL AVE, STE 322, INDIANAPOLIS, IN 46202-1476
(317) 962-2929
(317) 962-2070
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
28092723A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71003487A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201005500
—
IN
Enumeration date
11/18/2010
Last updated
05/11/2015
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