Provider Demographics
NPI:1396706537
Name:BUNNOW, JENNIFER S (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:BUNNOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 PLATEAU ST
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-4200
Mailing Address - Country:US
Mailing Address - Phone:828-488-4205
Mailing Address - Fax:828-488-4240
Practice Address - Street 1:45 PLATEAU ST
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-4200
Practice Address - Country:US
Practice Address - Phone:828-488-4205
Practice Address - Fax:828-488-4240
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891354JMedicaid
NC891354JMedicaid
H73778Medicare UPIN