Healthcare Provider Details

I. General information

NPI: 1225225006
Provider Name (Legal Business Name): DONNA EVON BUNKERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E VIRGINIA AVE SUITE 101
PHOENIX AZ
85004-1206
US

IV. Provider business mailing address

333 E VIRGINIA AVE SUITE 101
PHOENIX AZ
85004
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-4219
  • Fax: 602-254-5178
Mailing address:
  • Phone: 602-257-4219
  • Fax: 602-254-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3615
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: