Provider Demographics
NPI:1134363856
Name:MUNN, TERESSA MICHAUNE
Entity type:Individual
Prefix:
First Name:TERESSA
Middle Name:MICHAUNE
Last Name:MUNN
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 1:421 MAIDEN LN
Mailing Address - Street 2:SUITE 218
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5055
Mailing Address - Country:US
Mailing Address - Phone:910-223-3142
Mailing Address - Fax:910-223-3143
Practice Address - Street 1:421 MAIDEN LN
Practice Address - Street 2:SUITE 218
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5055
Practice Address - Country:US
Practice Address - Phone:910-223-3142
Practice Address - Fax:910-223-3143
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant