Provider Demographics
NPI:1194053777
Name:BUNNELL, MAURICE EDWARDS (APRN)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:EDWARDS
Last Name:BUNNELL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1610
Mailing Address - Country:US
Mailing Address - Phone:203-503-3300
Mailing Address - Fax:
Practice Address - Street 1:232 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1610
Practice Address - Country:US
Practice Address - Phone:203-503-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002910363LP0808X
CT2910363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008050090OtherBUNNELL MEDICAID
CTD400292158OtherBUNNELL MEDICARE
CT008003745Medicaid
CT004041000Medicaid