Provider Demographics
NPI:1336438381
Name:BUNCH, CHERRYL KATHLINE
Entity Type:Individual
Prefix:MRS
First Name:CHERRYL
Middle Name:KATHLINE
Last Name:BUNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 1085
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-8708
Mailing Address - Country:US
Mailing Address - Phone:918-797-2280
Mailing Address - Fax:
Practice Address - Street 1:716 S 2ND ST STE 101
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-4806
Practice Address - Country:US
Practice Address - Phone:918-696-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator