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General NPI Number Information
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NPI Number | 1083005987
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Entity Type | Organization
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Legal Business Name | PAMLICO FAMILY MEDICINE & WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 1203 CAROLINA AVE
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City | WASHINGTON
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State | NC
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Zip | 27889-3571
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Country | US
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Telephone | 252-623-2116
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Fax | 252-833-0230
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Provider Business Mailing Address
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Address Line | 1203 CAROLINA AVE
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City | WASHINGTON
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State | NC
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Zip | 27889-3571
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Country | US
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Telephone | 252-623-2116
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Fax | 252-833-0230
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Authorized Official
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Title or Position | OWNER/FAMILY NURSE PRACTITIONER
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Name | AMANDA C BUNCH
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Credential | FNP
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Telephone | 252-944-3867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 201701
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License Number State | NC
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