MEDICARE: MRS. PENELOPE SMITH HUNSUCKER NURSE PRACTITIONER

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
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	800079	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	800079	OTHER	NC	STATE PRESCRIBING NUMBER

General Provider Information

NPI Number	:	1720002710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENELOPE SMITH HUNSUCKER NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6600 CENTRAL DR
Second Line	:
City	:	CONOVER
State	:	NC
Zip	:	28613-7722
Country	:	US
Telephone Number	:	828-695-5822
Fax Number	:	828-695-4437

Provider Business Practice Location Address
First Line	:	3070 11TH AVENUE DR SE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-8336
Country	:	US
Telephone Number	:	828-695-5822
Fax Number	:	828-695-4437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/09/2007

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