=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518725530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKALA MARINDA CLARK BUNCH RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2024
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 GENERAL DE GAULLE DR
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70131-7247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-394-5991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 LISKA ST
-----------------------------------------------------
City | WESTWEGO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70094-2157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-256-1502
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WW0000X
-----------------------------------------------------
Taxonomy Name | Wound Care Registered Nurse
-----------------------------------------------------
License Number | 208951
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WC2100X
-----------------------------------------------------
Taxonomy Name | Continence Care Registered Nurse
-----------------------------------------------------
License Number | 208951
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WX1500X
-----------------------------------------------------
Taxonomy Name | Ostomy Care Registered Nurse
-----------------------------------------------------
License Number | 208951
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------