Provider Demographics
NPI:1215774005
Name:GUNNER, ELISABETH NICOLE
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:NICOLE
Last Name:GUNNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 52
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311
Mailing Address - Country:US
Mailing Address - Phone:559-397-1417
Mailing Address - Fax:
Practice Address - Street 1:6761 LIMA ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43324
Practice Address - Country:US
Practice Address - Phone:559-397-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant