Provider Demographics
NPI:1508836818
Name:LUNSFORD, MARJORIE N (RNC, FNP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:N
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:RNC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 BIG CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:TN
Mailing Address - Zip Code:37753-2220
Mailing Address - Country:US
Mailing Address - Phone:423-487-2240
Mailing Address - Fax:423-487-3707
Practice Address - Street 1:4261 BIG CREEK RD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:TN
Practice Address - Zip Code:37753-2220
Practice Address - Country:US
Practice Address - Phone:423-487-2240
Practice Address - Fax:423-487-3707
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN53243163W00000X
TNAPN5598363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3343881Medicaid
TN3032441OtherBLUECARE-GRASSY FORK
TN100010532OtherPHP TENNCARE
TN3032442OtherBCBST
TN3032442OtherBCBST