Provider Demographics
NPI:1558728881
Name:BUNCH, REBECCA (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BUNCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-4652
Mailing Address - Country:US
Mailing Address - Phone:937-603-9680
Mailing Address - Fax:
Practice Address - Street 1:474 N YELLOW SPRINGS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2463
Practice Address - Country:US
Practice Address - Phone:937-399-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.467811163W00000X
390200000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program