Healthcare Provider Details

I. General information

NPI: 1639799729
Provider Name (Legal Business Name): JULIANNA BUNKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 UNIVERSITY BLVD
BIRMINGHAM AL
35294-6328
US

IV. Provider business mailing address

434 PATRIOTS POINT LN
SWANSBORO NC
28584-8850
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-5428
  • Fax:
Mailing address:
  • Phone: 910-389-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024182792
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number296344
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: