Provider Demographics
NPI:1760698690
Name:BUNCH, CORINNE ROBERTA (NR)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:ROBERTA
Last Name:BUNCH
Suffix:
Gender:F
Credentials:NR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6837 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:POLLOCK PINES
Mailing Address - State:CA
Mailing Address - Zip Code:95726-9503
Mailing Address - Country:US
Mailing Address - Phone:530-647-2647
Mailing Address - Fax:530-644-3003
Practice Address - Street 1:6837 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:POLLOCK PINES
Practice Address - State:CA
Practice Address - Zip Code:95726-9503
Practice Address - Country:US
Practice Address - Phone:530-647-2647
Practice Address - Fax:530-644-3003
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363849163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS016570Medicaid
CARVN004730Medicaid