Provider Demographics
NPI:1235685058
Name:BUNCE-HOUSTON, MARIANNE RENE (RN, CNS)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:RENE
Last Name:BUNCE-HOUSTON
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 VIOLET CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3834
Mailing Address - Country:US
Mailing Address - Phone:707-747-6139
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR ROAD
Practice Address - Street 2:VA NORTHERN CALIFORNIA HEALTH CARE SYSTEM
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:925-372-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411161163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA411161OtherCALIFORNIA BOARD OF REGISTERED NURSING
CA50OtherCALIFORNIA BOARD OF REGISTERED NURSING