Healthcare Provider Details

I. General information

NPI: 1841340122
Provider Name (Legal Business Name): TAMBRA JOAN HUNTER B.A.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MARTINSVILLE ST
GREENCASTLE IN
46135-2233
US

IV. Provider business mailing address

313 ELM ST APT C
GREENCASTLE IN
46135-2080
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-2018
  • Fax: 765-653-6171
Mailing address:
  • Phone: 765-720-2753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: