Provider Demographics
NPI:1124307335
Name:BUNYAN, BRANDI D
Entity type:Individual
Prefix:MISS
First Name:BRANDI
Middle Name:D
Last Name:BUNYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N STRATFORD LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1139
Mailing Address - Country:US
Mailing Address - Phone:316-425-5509
Mailing Address - Fax:316-425-3648
Practice Address - Street 1:1425 N STRATFORD LN
Practice Address - Street 2:307
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1139
Practice Address - Country:US
Practice Address - Phone:316-425-5509
Practice Address - Fax:316-425-3648
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB087184164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse