Provider Demographics
NPI:1366153207
Name:BUNCH, HANNAH VAIL (PA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:VAIL
Last Name:BUNCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 JACKSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-4850
Mailing Address - Country:US
Mailing Address - Phone:423-201-9937
Mailing Address - Fax:
Practice Address - Street 1:2702 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-4850
Practice Address - Country:US
Practice Address - Phone:423-201-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical