Healthcare Provider Details

I. General information

NPI: 1316927767
Provider Name (Legal Business Name): JUNE REBECCA TUNSTALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401-405 HOPEWELL STREET
HOPEWELL VA
23860-2817
US

IV. Provider business mailing address

67 COLONIAL TRL E PO BOX 354
SURRY VA
23883-9997
US

V. Phone/Fax

Practice location:
  • Phone: 804-458-6396
  • Fax: 804-458-4934
Mailing address:
  • Phone: 757-294-3188
  • Fax: 757-294-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101029877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: