=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003002064
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE GUNN TURNER NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2007
-----------------------------------------------------
Last Update Date | 09/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 RIVERMONT AVE INTENSIVE CARE NURSERY
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24503-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-200-5735
-----------------------------------------------------
Fax | 434-200-4590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 WOODMONT LN
-----------------------------------------------------
City | FOREST
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24551-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-525-8266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LN0000X
-----------------------------------------------------
Taxonomy Name | Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | 0024082806
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------