Individual
KHATIFA BUNDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2327 W HAGERT ST, PHILADELPHIA, PA 19132-4246
(267) 736-0893
Mailing address
2327 W HAGERT ST, PHILADELPHIA, PA 19132-4246
(267) 736-0893
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN312123
PA
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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