Provider Demographics
NPI:1598590416
Name:BUNKLEY, TANESHA
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:BUNKLEY
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 1:15682 CORAM ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2502
Mailing Address - Country:US
Mailing Address - Phone:586-943-4369
Mailing Address - Fax:
Practice Address - Street 1:15682 CORAM ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2502
Practice Address - Country:US
Practice Address - Phone:313-423-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No376K00000XNursing Service Related ProvidersNurse's Aide