Provider Demographics
NPI:1942367271
Name:HUNNER, MARY ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:HUNNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-7512
Mailing Address - Country:US
Mailing Address - Phone:505-521-1554
Mailing Address - Fax:505-556-1754
Practice Address - Street 1:2530 S. TELSHOR BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:505-521-1554
Practice Address - Fax:505-556-1754
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR22864363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care