Provider Demographics
NPI:1396093027
Name:BUNCE, JOANN P (NP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:P
Last Name:BUNCE
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 1:220 W ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4297
Mailing Address - Country:US
Mailing Address - Phone:989-832-6663
Mailing Address - Fax:989-832-6628
Practice Address - Street 1:220 W ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5194
Practice Address - Country:US
Practice Address - Phone:989-832-6663
Practice Address - Fax:989-832-6628
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704101545363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704101545OtherSTATE LICENSE