Provider Demographics
NPI:1275726507
Name:BUNN, EBONY IANDTHY (LPN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:IANDTHY
Last Name:BUNN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 LEE RD APT 406
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2155
Mailing Address - Country:US
Mailing Address - Phone:216-932-3216
Mailing Address - Fax:
Practice Address - Street 1:1823 LEE RD APT 406
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-2155
Practice Address - Country:US
Practice Address - Phone:216-932-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN124778164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse