Provider Demographics
NPI:1063964799
Name:BUNKER HILL STAFFING LLC
Entity type:Organization
Organization Name:BUNKER HILL STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-528-7312
Mailing Address - Street 1:1300 BUNKER HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4096
Mailing Address - Country:US
Mailing Address - Phone:931-528-7312
Mailing Address - Fax:931-528-7377
Practice Address - Street 1:1300 BUNKER HILL RD STE A
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506
Practice Address - Country:US
Practice Address - Phone:931-528-7312
Practice Address - Fax:931-528-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1518238484363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty