Provider Demographics
NPI:1841633856
Name:BUNN, ELISE RACHELLE (PA)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:RACHELLE
Last Name:BUNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:RACHELLE
Other - Last Name:NATTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8036
Mailing Address - Country:US
Mailing Address - Phone:919-781-7500
Mailing Address - Fax:
Practice Address - Street 1:3100 BLUE RIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8036
Practice Address - Country:US
Practice Address - Phone:919-781-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03916363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant