Provider Demographics
NPI:1811362403
Name:MUNYUA, ALICE W (NP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:W
Last Name:MUNYUA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHERRY HOSPITAL
Mailing Address - Street 2:1401 WEST ASH STREET
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-1078
Mailing Address - Country:US
Mailing Address - Phone:919-593-3812
Mailing Address - Fax:
Practice Address - Street 1:CHERRY HOSPITAL
Practice Address - Street 2:1401 WEST ASH STREET
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1078
Practice Address - Country:US
Practice Address - Phone:919-593-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC140856363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1Medicaid