Provider Demographics
NPI:1154711638
Name:MUNGLE, MARY (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MUNGLE
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 1:300 STEAM PLANT RD
Mailing Address - Street 2:STE 300
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3032
Mailing Address - Country:US
Mailing Address - Phone:615-230-8070
Mailing Address - Fax:615-898-4661
Practice Address - Street 1:300 STEAM PLANT RD
Practice Address - Street 2:STE 300
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3032
Practice Address - Country:US
Practice Address - Phone:615-230-8070
Practice Address - Fax:615-898-4661
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000019557363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner