Individual
THERESA BUNKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1410 NE 106TH AVE, PORTLAND, OR 97220-3934
(503) 460-0405
(503) 460-0434
Mailing address
1410 NE 106TH AVE, PORTLAND, OR 97220-3934
(503) 460-0405
(503) 460-0434
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
096006685N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210222
—
OR
Enumeration date
11/08/2006
Last updated
07/20/2010
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