Provider Demographics
NPI:1205441979
Name:BUNDT, ANDREW PAUL (CRNA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
Last Name:BUNDT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-8284
Mailing Address - Country:US
Mailing Address - Phone:228-596-9234
Mailing Address - Fax:
Practice Address - Street 1:2704 W OXFORD LOOP
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5723
Practice Address - Country:US
Practice Address - Phone:662-550-4299
Practice Address - Fax:662-580-4324
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS887970163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty