Healthcare Provider Details

I. General information

NPI: 1154576221
Provider Name (Legal Business Name): TANYA J. MUNGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA J. MONTAVON/WHITMAN NP

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 DUKE MEDICINE CIR # 1A
DURHAM NC
27710-3000
US

IV. Provider business mailing address

30 DUKE MEDICINE CIRCLE CLINIC 1A SUITE 222
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 815-871-1115
  • Fax:
Mailing address:
  • Phone: 815-871-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209007248
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number309003966
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5016236
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041322477
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: