=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568179497
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY O'NEAL BUNCH APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2022
-----------------------------------------------------
Last Update Date | 11/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 SERPENTINE DR STE 200
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29303-3066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-560-7050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 FAIN DR
-----------------------------------------------------
City | BOILING SPRINGS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29316-6030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-909-2470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 26316
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------