MEDICARE: AMANDA MARIE BUNNELL MSW

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	171M00000X	Case Manager/Care Coordinator		KS

General Provider Information

NPI Number	:	1740584523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE BUNNELL MSW

Provider Business Mailing Address
First Line	:	1015 PIERRE ST
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-5448
Country	:	US
Telephone Number	:	785-565-2631
Fax Number	:	785-537-0530

Provider Business Practice Location Address
First Line	:	1015 PIERRE ST
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-5448
Country	:	US
Telephone Number	:	785-565-2631
Fax Number	:	785-537-0530

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

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	01/07/2011

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