Healthcare Provider Details

I. General information

NPI: 1285950311
Provider Name (Legal Business Name): MRS. KATHERINE ELAINE BUNZE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S ASSEMBLY
SPOKANE WA
99224
US

IV. Provider business mailing address

PO BOX 19462
SPOKANE WA
99219-9462
US

V. Phone/Fax

Practice location:
  • Phone: 509-475-5597
  • Fax:
Mailing address:
  • Phone: 509-475-5597
  • Fax: 509-838-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number0948-67806
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: