MEDICARE: MS. MARSHA LYNN BUNNEY CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	R0033298	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	R0033298	OTHER	OK	LICENSE

General Provider Information

NPI Number	:	1366440703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARSHA LYNN BUNNEY CNS

Provider Business Mailing Address
First Line	:	1 PLAZA SOUTH ST
Second Line	:	PMB 261
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-4750
Country	:	US
Telephone Number	:	918-931-2835
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 HONOR HEIGHTS DR
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-1318
Country	:	US
Telephone Number	:	918-680-3699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/09/2007

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