Provider Demographics
NPI:1366409385
Name:BUNTE, STACY (CRNA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BUNTE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:800 EAST CARPENTER STREET
Mailing Address - Street 2:ROOM 2K64
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62769-0001
Mailing Address - Country:US
Mailing Address - Phone:217-525-5643
Mailing Address - Fax:217-544-3311
Practice Address - Street 1:800 EAST CARPENTER STREET
Practice Address - Street 2:ROOM 2K64
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-525-5643
Practice Address - Fax:217-544-3311
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005948367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0841504038OtherBLUE CROSS
IL104409OtherHEALTHLINK GROUP #
IL371115308OtherCHAMPUS/TRICARE
IL735721OtherHEALTHLINK INDIVIDUAL #
IL041334433Medicaid
ILP00297680Medicare ID - Type UnspecifiedMEDICARE RR
IL104409OtherHEALTHLINK GROUP #