Provider Demographics
NPI:1710640941
Name:HUNNELL, TAMMY RENE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENE
Last Name:HUNNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHADY GROVE VLG
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2171
Mailing Address - Country:US
Mailing Address - Phone:304-376-6049
Mailing Address - Fax:
Practice Address - Street 1:5 SHADY GROVE VLG
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2171
Practice Address - Country:US
Practice Address - Phone:304-376-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant