| Doctor Name: | MS. MARY BUNKER |
| NPI Number: | 1457481871 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | R11321 |
| Business Practice Address: | State Hwy 518, Mile Marker 29 Mora, NM - 877320185 |
| Business Phone Number: | 5053875503 |
| Business Fax Number: | 5053875502 |
| Mailing Address: | Po Box 185, MORA |
| State: | NM |
| Postal Code: | 877320185 |
| Phone Number: | 5053875503 |
| Fax Number: | 5053875502 |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R11321 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |