Healthcare Provider Details

I. General information

NPI: 1831265354
Provider Name (Legal Business Name): ANNETTE DEWITTE BUNN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E MITCHELL DR
PHOENIX AZ
85012-2330
US

IV. Provider business mailing address

202 E EARLL DR STE 200
PHOENIX AZ
85012-2647
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-6868
  • Fax: 360-336-6866
Mailing address:
  • Phone: 602-808-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP3928
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: