Provider Demographics
NPI:1487153367
Name:BUNKER, CASSANDRA MEGHANN (NP-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MEGHANN
Last Name:BUNKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 DASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4401
Mailing Address - Country:US
Mailing Address - Phone:248-227-1460
Mailing Address - Fax:
Practice Address - Street 1:44199 DEQUINDRE RD STE 615
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-964-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382948363L00000X
MI4704297171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner