Provider Demographics
NPI:1720002710
Name:HUNSUCKER, PENELOPE SMITH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:SMITH
Last Name:HUNSUCKER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-7722
Mailing Address - Country:US
Mailing Address - Phone:828-695-5822
Mailing Address - Fax:828-695-4437
Practice Address - Street 1:3070 11TH AVENUE DR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8336
Practice Address - Country:US
Practice Address - Phone:828-695-5822
Practice Address - Fax:828-695-4437
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800079363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC800079OtherSTATE PRESCRIBING NUMBER
NCS96229Medicare UPIN
NC800079OtherSTATE PRESCRIBING NUMBER