Provider Demographics
NPI:1295730935
Name:BUNKER-ALBERTS, MICHELE VIVIENE (MSN, FNP, IBCLC)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:VIVIENE
Last Name:BUNKER-ALBERTS
Suffix:
Gender:F
Credentials:MSN, FNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CARLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1732
Mailing Address - Country:US
Mailing Address - Phone:510-834-2824
Mailing Address - Fax:
Practice Address - Street 1:39500 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2211
Practice Address - Country:US
Practice Address - Phone:510-770-8133
Practice Address - Fax:510-770-8142
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ23804Medicare UPIN