Provider Demographics
NPI:1750896866
Name:GUNG, CAROL (RN, MSN, AGNP-BC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:GUNG
Suffix:
Gender:F
Credentials:RN, MSN, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 LONGSHORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1815
Mailing Address - Country:US
Mailing Address - Phone:267-205-2727
Mailing Address - Fax:
Practice Address - Street 1:925 CHESTNUT ST STE 420A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:215-955-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN302959L363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology