Individual
MS. SUSAN LYNN BUNNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2280 E 25TH STREET, IDAHO FALLS, ID 83404
(208) 227-2295
(208) 227-2364
Mailing address
2280 E 25TH STREET, IDAHO FALLS, ID 83404
(208) 227-2295
(208) 227-2364
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
5576
SD
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
M11154
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13426216975
—
ID
01
—
4994379
BCBS
SD
05
—
7101880
—
SD
Enumeration date
02/24/2006
Last updated
12/16/2011
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