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General NPI Number Information
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NPI Number | 1225024060
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Entity Type | Individual
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Provider Name | SUSAN EILEEN BUNNER CNP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 859 N MAIN ST
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City | MALTA
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State | OH
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Zip | 43758-9007
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Country | US
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Telephone | 740-962-6111
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Fax | 740-962-1657
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Provider Business Mailing Address
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Address Line | 5700 TUNIS RD
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City | ZANESVILLE
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State | OH
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Zip | 43701-8838
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Country | US
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Telephone | 740-453-4416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | RN133264
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | COA.00853NP
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License Number State | OH
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