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NPI Code Detail

MEDICARE: TENESSA R MUNAL NP-C

MEDICARE: TENESSA R MUNAL NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner21137TN
2363L00000XNurse Practitioner21137TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114472883
Entity Type Code : Individual
Provider Name (Legal Business Name) : TENESSA R MUNAL NP-C
Provider Business Mailing Address
First Line : 215 E SPRINGBROOK DR
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-1761
Country : US
Telephone Number : 423-794-5550
Fax Number : 423-794-5867
Provider Business Practice Location Address
First Line : 301 MED TECH PKWY
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-2630
Country : US
Telephone Number : 423-794-5550
Fax Number : 423-794-5867
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2016
Last Update Date : 12/03/2020

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