Provider Demographics
NPI:1457411910
Name:BUNZEL, DIANA L (CNS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:BUNZEL
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 LEGENDS TER
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9527
Mailing Address - Country:US
Mailing Address - Phone:831-521-4620
Mailing Address - Fax:843-388-5024
Practice Address - Street 1:955 LEGENDS TER
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9527
Practice Address - Country:US
Practice Address - Phone:831-521-4620
Practice Address - Fax:843-388-5024
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 3178364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult