Provider Demographics
NPI:1457481871
Name:BUNKER, MARY (CNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:BUNKER
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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0185
Mailing Address - Country:US
Mailing Address - Phone:505-387-5503
Mailing Address - Fax:505-387-5502
Practice Address - Street 1:STATE HWY 518, MILE MARKER 29
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-0185
Practice Address - Country:US
Practice Address - Phone:505-387-5503
Practice Address - Fax:505-387-5502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR11321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily