Provider Demographics
NPI:1760954242
Name:TUNG, NDEMAFIA
Entity Type:Individual
Prefix:
First Name:NDEMAFIA
Middle Name:
Last Name:TUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILLIAMSBURG DR APT 614
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5782
Mailing Address - Country:US
Mailing Address - Phone:256-652-0343
Mailing Address - Fax:
Practice Address - Street 1:1 WILLIAMSBURG DR APT 614
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-5782
Practice Address - Country:US
Practice Address - Phone:256-652-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123973367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered