Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Laken Bungo

Individual provider Registered Nurse · NPI 1255171112

Laken Bungo is a Nurse Practitioner in Indiana, Pennsylvania. Qualified in 2025, 1 year ago. Works from 2 locations. Licensed in Pennsylvania.

Years since qualifying
1
Licensed in
PA
In the registry since
2024
Specialties on file
2

Practice location Address checks out

625 Rustic Lodge Rd
Indiana, PA 15701-3403
Phone: (724) 463-3720
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9603 Highway 422 W, Shelocta, PA 15774 — (724) 801-1240

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence SP034738 (PA)
Registered Nurse Taxonomy 163W00000X · Licence RN711984 (PA)

Record details

NPI number1255171112
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 29, 2024
Last updated in NPPESDecember 22, 2025
Certification dateDecember 22, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated

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