| NPI | 1295722478 |
|---|---|
| Former Name | STACY I BUNTEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1787) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16583) |
| 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1787) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2024-02-21 |