Healthcare Provider Details

I. General information

NPI: 1902381221
Provider Name (Legal Business Name): ROBERT JOSEPH BUNNELL CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 CORSON AVE S
SEATTLE WA
98108-2323
US

IV. Provider business mailing address

5008 CORSON AVE S
SEATTLE WA
98108-2323
US

V. Phone/Fax

Practice location:
  • Phone: 206-602-9361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00968569
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number00281602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: