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General NPI Number Information
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NPI Number | 1598069957
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Entity Type | Organization
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Legal Business Name | HOMEBOUND PRIMARY CARE LLC
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 18211 GIFFORD RD
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City | WELLINGTON
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State | OH
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Zip | 44090-8910
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Country | US
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Telephone | 855-550-5605
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 208
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City | WELLINGTON
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State | OH
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Zip | 44090-0208
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Country | US
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Telephone | 855-550-5605
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CHRISTEN MARIE GUNDER
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Credential | RN,BSN, MSN, ANP-BC
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Telephone | 855-550-5605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 10202
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License Number State | OH
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