Basic Information
| Provider Information | |||||||||
| NPI: | 1508376484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAUNEY | ||||||||
| FirstName: | LORENA | ||||||||
| MiddleName: | DUNBAR | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4734 LONG BEACH RD SE | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284618721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104570070 | ||||||||
| FaxNumber: | 9102678936 | ||||||||
| Practice Location | |||||||||
| Address1: | 4734 LONG BEACH RD SE | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284618721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104570070 | ||||||||
| FaxNumber: | 9102678936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2017 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5009942 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 5009942 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.