Healthcare Provider Details

I. General information

NPI: 1639422140
Provider Name (Legal Business Name): NANCY JUNE MUNGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 HOSPITAL LOOP
OWYHEE NV
89832
US

IV. Provider business mailing address

PO BOX 130 1623 HOSPITAL LOOP
OWYHEE NV
89832-0130
US

V. Phone/Fax

Practice location:
  • Phone: 775-757-2060
  • Fax: 775-757-2441
Mailing address:
  • Phone: 775-757-2060
  • Fax: 775-757-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN56464
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN56464
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: