Healthcare Provider Details

I. General information

NPI: 1215204292
Provider Name (Legal Business Name): DIANNE LOUISE BUNNER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 N MCKENZIE ST
FOLEY AL
36535-2247
US

IV. Provider business mailing address

1613 N MCKENZIE ST
FOLEY AL
36535-2247
US

V. Phone/Fax

Practice location:
  • Phone: 251-949-3710
  • Fax: 251-949-3715
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number1-088480
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberCOA.12665-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: