Provider Demographics
NPI:1225024060
Name:BUNNER, SUSAN EILEEN (CNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:EILEEN
Last Name:BUNNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 TUNIS RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-8838
Mailing Address - Country:US
Mailing Address - Phone:740-453-4416
Mailing Address - Fax:
Practice Address - Street 1:859 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758-9007
Practice Address - Country:US
Practice Address - Phone:740-962-6111
Practice Address - Fax:740-962-1657
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN133264163WP0200X
OHCOA.00853NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3293887Medicaid
OH3293887Medicaid
OHP23177Medicare UPIN