Provider Demographics
NPI:1144723867
Name:FIRA, BUNNY (LVN)
Entity type:Individual
Prefix:
First Name:BUNNY
Middle Name:
Last Name:FIRA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MARLANDWOOD RD STE 118
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3341
Mailing Address - Country:US
Mailing Address - Phone:254-410-7226
Mailing Address - Fax:
Practice Address - Street 1:1005 MARLANDWOOD RD STE 118
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3341
Practice Address - Country:US
Practice Address - Phone:254-410-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219532164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse