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NPI Code Detail

MEDICARE: NICOLE BUNNER LSAA

MEDICARE: NICOLE BUNNER LSAA
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCTB20220700NM
2101Y00000XCounselorCTB-2022-0700NM

General Provider Information

NPI Number : 1841942240
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE BUNNER LSAA
Provider Business Mailing Address
First Line : 653 W ARRINGTON ST
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-8513
Country : US
Telephone Number : 505-564-3733
Fax Number :
Provider Business Practice Location Address
First Line : 228 N SCHWARTZ AVE
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-5547
Country : US
Telephone Number : 505-327-4584
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2022
Last Update Date : 01/14/2026

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Directions to “ NICOLE BUNNER LSAA” Practice Location

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