Provider Demographics
NPI:1376891143
Name:BUNTYN, JEANETTE ELAINE (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ELAINE
Last Name:BUNTYN
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3324
Mailing Address - Country:US
Mailing Address - Phone:731-855-7982
Mailing Address - Fax:731-927-7642
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3324
Practice Address - Country:US
Practice Address - Phone:731-855-7982
Practice Address - Fax:731-927-7642
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator