Provider Demographics
NPI:1346260718
Name:BUNAG- BOEHM, EMMA G (RN, MSN,APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:G
Last Name:BUNAG- BOEHM
Suffix:
Gender:F
Credentials:RN, MSN,APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3793 HERMES DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-5021
Mailing Address - Country:US
Mailing Address - Phone:513-475-6549
Mailing Address - Fax:513-475-6640
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-475-6549
Practice Address - Fax:513-475-6640
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN 102119363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health