Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 19765 | WV |
NPI | 1013913011 |
---|---|
Provider Name | Julie Suzanne Bunner |
First Address | Wheeling, WV 26003-3660 |
Second Address | Wheeling, WV 26003-3660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 09/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001718176 | MOUNTAIN STATE BCBS (01) | |
1812151000 | (05) | WV |
19765 | HEALTH PLAN OF UPPER OH V (01) | |
2325353 | (05) | OH |
55035705701 | WV COMPENSATION (01) | WV |
H57848 | (02) |