Provider Demographics
NPI:1649637786
Name:BUNN, DENISE (RT(R)(CT))
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BUNN
Suffix:
Gender:F
Credentials:RT(R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 BRIDLE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-3432
Mailing Address - Country:US
Mailing Address - Phone:605-580-2283
Mailing Address - Fax:
Practice Address - Street 1:1660 BRIDLE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-3432
Practice Address - Country:US
Practice Address - Phone:605-580-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3240872471C3401X
AZ138132471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography