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General NPI Number Information
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NPI Number | 1992286314
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Entity Type | Individual
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Provider Name | DONNA LYNN BUNCH
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Gender | Female
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 950 CAMPTON ST
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City | ELY
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State | NV
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Zip | 89301-1965
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Country | US
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Telephone | 970-690-6170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | LUND
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State | NV
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Zip | 89317-0023
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Country | US
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Telephone | 970-690-6170
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 0306072861
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License Number State | NV
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