Healthcare Provider Details

I. General information

NPI: 1598590416
Provider Name (Legal Business Name): TANESHA BUNKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15682 CORAM ST
DETROIT MI
48205-2502
US

IV. Provider business mailing address

15682 CORAM ST
DETROIT MI
48205-2502
US

V. Phone/Fax

Practice location:
  • Phone: 313-423-2258
  • Fax:
Mailing address:
  • Phone: 586-943-4369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: