Healthcare Provider Details

I. General information

NPI: 1861140477
Provider Name (Legal Business Name): PAIGE BUNKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S WHITLEY DR STE 2
FRUITLAND ID
83619-2681
US

IV. Provider business mailing address

1126 NW 23RD ST
FRUITLAND ID
83619-2195
US

V. Phone/Fax

Practice location:
  • Phone: 208-230-7452
  • Fax:
Mailing address:
  • Phone: 208-329-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-42654
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: