Healthcare Provider Details

I. General information

NPI: 1205606423
Provider Name (Legal Business Name): TRISHANNA NICOLE BUNSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3933 MAIN ST
STRATFORD CT
06614-3546
US

V. Phone/Fax

Practice location:
  • Phone: 410-772-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP200006507
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: