Provider Demographics
NPI:1528364627
Name:BUNTON, ANJA SUSANNE
Entity type:Individual
Prefix:
First Name:ANJA
Middle Name:SUSANNE
Last Name:BUNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANJA
Other - Middle Name:SUSANNE
Other - Last Name:SONNENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2303
Mailing Address - Country:US
Mailing Address - Phone:314-604-3049
Mailing Address - Fax:
Practice Address - Street 1:1430 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2303
Practice Address - Country:US
Practice Address - Phone:314-604-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist