1093281362 NPI number — EVELYN HAYDEN BUNCE APRN-CNP, DNP

Table of content: EVELYN HAYDEN BUNCE APRN-CNP, DNP (NPI 1093281362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093281362 NPI number — EVELYN HAYDEN BUNCE APRN-CNP, DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUNCE
Provider First Name:
EVELYN
Provider Middle Name:
HAYDEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-CNP, DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093281362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 PORTLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACO
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04072-9005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-221-2467
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 ANDOVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTBROOK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04092-3850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-761-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  CNP181166 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CNP181166 . This is a "ADVANCED PRACTICE REGISTERED NURSE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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