Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 930010 | NC |
NPI | 1083988075 |
---|---|
Provider Name | Mrs. Tina Thomason Hunsucker |
First Address | Greensboro, NC 27455-2005 |
Second Address | Greensboro, NC 27408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 08/03/2012 |