Laken Bungo

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

SP034738 Issued in PA

Practice address

625 Rustic Lodge Rd
Indiana, PA 15701-3403

Phone

(724) 463-3720

NPI assigned

May 29, 2024

Reactivated

Dec 22, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Laken Bungo Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shenggao Han, M.D., LLC

  • Internal Medicine Physician
  • Indiana, PA
  • NPI 1902843170
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1255171112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 RUSTIC LODGE RD",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013403",
            "telephone_number": "724-463-3720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 RUSTIC LODGE RD",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013403",
            "telephone_number": "724-463-3720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9603 Highway 422 W",
            "address_purpose": "LOCATION",
            "city": "Shelocta",
            "state": "PA",
            "postal_code": "15774",
            "country_code": "US",
            "telephone_number": "724-801-1240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNGO",
        "first_name": "LAKEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-29",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "deactivation_date": "2025-12-15",
        "reactivation_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN711984",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP034738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAKEN",
            "last_name": "BUNGO",
            "prefix": "MRS.",
            "credential": "CRNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brandie Bryant
• Kayla Bryant, DO
• Deborah E. Budash, O.T.
• Dylan Patrick Buffington
• Marie Louise Buggey
• Edna Iona Burford, CRNP
• Juliann N Burke, COTA/L
• Jordan Kathryn Burkett
• Carissa Burns, BS
• Bruce A Bush, MD

• Nurse Practitioner in Indiana, PA
• Providers in Indiana, PA by specialty
• Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.