Provider Demographics
NPI:1841734282
Name:BUNN, BENNETTE
Entity type:Individual
Prefix:
First Name:BENNETTE
Middle Name:
Last Name:BUNN
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 1:3017 DOUGLAS BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3848
Mailing Address - Country:US
Mailing Address - Phone:916-745-4499
Mailing Address - Fax:
Practice Address - Street 1:3017 DOUGLAS BLVD
Practice Address - Street 2:STE 300
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3848
Practice Address - Country:US
Practice Address - Phone:916-745-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health