Provider Demographics
NPI:1053164590
Name:SUNDERMAN, JOHN HENRY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:SUNDERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MICHAEL CIR NE
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-7617
Mailing Address - Country:US
Mailing Address - Phone:205-534-0212
Mailing Address - Fax:
Practice Address - Street 1:26 MICHAEL CIR NE
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-7617
Practice Address - Country:US
Practice Address - Phone:205-534-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-182604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse