Healthcare Provider Details

I. General information

NPI: 1366440703
Provider Name (Legal Business Name): MARSHA LYNN BUNNEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

IV. Provider business mailing address

1 PLAZA SOUTH ST PMB 261
TAHLEQUAH OK
74464-4750
US

V. Phone/Fax

Practice location:
  • Phone: 918-680-3699
  • Fax:
Mailing address:
  • Phone: 918-931-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR0033298
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: