Provider Demographics
NPI:1699008300
Name:BUNDU, USMAN JAWA (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:USMAN
Middle Name:JAWA
Last Name:BUNDU
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18224 N 168TH AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-6868
Mailing Address - Country:US
Mailing Address - Phone:602-918-0408
Mailing Address - Fax:623-444-6989
Practice Address - Street 1:18224 N 168TH AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-6868
Practice Address - Country:US
Practice Address - Phone:602-918-0408
Practice Address - Fax:623-444-6989
Is Sole Proprietor?:No
Enumeration Date:2009-09-13
Last Update Date:2009-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3442103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst