Provider Demographics
NPI:1285950311
Name:BUNZE, KATHERINE ELAINE
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELAINE
Last Name:BUNZE
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:PO BOX 19462
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99219-9462
Mailing Address - Country:US
Mailing Address - Phone:509-475-5597
Mailing Address - Fax:509-838-0491
Practice Address - Street 1:809 S ASSEMBLY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224
Practice Address - Country:US
Practice Address - Phone:509-475-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0948-67806171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor