Provider Demographics
NPI:1972357606
Name:PURNELL, TUNEKO S
Entity type:Individual
Prefix:MRS
First Name:TUNEKO
Middle Name:S
Last Name:PURNELL
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 1:262 W MAIN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4169
Mailing Address - Country:US
Mailing Address - Phone:704-891-8565
Mailing Address - Fax:
Practice Address - Street 1:262 W MAIN AVE STE E
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4169
Practice Address - Country:US
Practice Address - Phone:704-891-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution