Provider Demographics
NPI:1336806637
Name:BUNCH, WINONA D (FNP)
Entity type:Individual
Prefix:MRS
First Name:WINONA
Middle Name:D
Last Name:BUNCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 CALVIN RD
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-4532
Mailing Address - Country:US
Mailing Address - Phone:912-550-6599
Mailing Address - Fax:
Practice Address - Street 1:1745 CALVIN RD
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-4532
Practice Address - Country:US
Practice Address - Phone:912-550-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner