Provider Demographics
NPI:1417664244
Name:MCCUNE, TAMMY (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 FISHHOOK LN
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-6574
Mailing Address - Country:US
Mailing Address - Phone:304-202-4854
Mailing Address - Fax:304-305-1597
Practice Address - Street 1:155 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3311
Practice Address - Country:US
Practice Address - Phone:304-202-4854
Practice Address - Fax:304-305-1597
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50365163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health