Provider Demographics
NPI:1053435412
Name:BUNTING, ELIZABETH MCNEILL (DSC, PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MCNEILL
Last Name:BUNTING
Suffix:
Gender:F
Credentials:DSC, PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MCNEILL
Other - Last Name:HEDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2697 ST JAMES DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8553
Mailing Address - Country:US
Mailing Address - Phone:910-469-4690
Mailing Address - Fax:910-933-7084
Practice Address - Street 1:226 N FRONT ST.
Practice Address - Street 2:#129
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3920
Practice Address - Country:US
Practice Address - Phone:910-469-4690
Practice Address - Fax:910-933-7084
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000817363A00000X, 363AM0700X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101306Medicaid
NCP01468254Medicare PIN
NC8101306Medicaid
NC2768728AMedicare UPIN