1104431923 NPI number — TAMMY HOPE BUNDY FERRON BSN RN

Table of content: TAMMY HOPE BUNDY FERRON BSN RN (NPI 1104431923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104431923 NPI number — TAMMY HOPE BUNDY FERRON BSN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRON
Provider First Name:
TAMMY
Provider Middle Name:
HOPE BUNDY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUNDY
Provider Other First Name:
TAMMY
Provider Other Middle Name:
HOPE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104431923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 FREEMAN MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMLET
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28345-8816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-334-1867
Provider Business Mailing Address Fax Number:
910-239-8742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 FREEMAN MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMLET
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28345-8816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-334-1867
Provider Business Practice Location Address Fax Number:
910-239-8742
Provider Enumeration Date:
09/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WE0003X , with the licence number:  271986 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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