Individual
TRACY E BUNNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5803 NEAL AVE N, OAK PARK HEIGHTS, MN 55082-2177
(651) 439-8807
(651) 439-0232
Mailing address
5803 NEAL AVE N, OAK PARK HEIGHTS, MN 55082-2177
(651) 439-8807
(651) 439-0232
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12367
MN
363A00000X
Physician Assistant
3974
WI
363A00000X
Physician Assistant
PAC0616
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134595978
—
MN
Enumeration date
08/17/2015
Last updated
11/29/2017
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