Healthcare Provider Details

I. General information

NPI: 1316441942
Provider Name (Legal Business Name): MARIANNE MARIE BUNCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W 7TH AVE STE 310
EUGENE OR
97401-2676
US

IV. Provider business mailing address

2073 OLYMPIC ST
SPRINGFIELD OR
97477-3413
US

V. Phone/Fax

Practice location:
  • Phone: 541-520-5957
  • Fax:
Mailing address:
  • Phone: 541-682-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number201390598RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number201390598RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: