Provider Demographics
NPI:1003039504
Name:NUNN, JANET LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:NUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 6TH AVE SE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1047
Mailing Address - Country:US
Mailing Address - Phone:360-956-3212
Mailing Address - Fax:
Practice Address - Street 1:4160 6TH AVE SE
Practice Address - Street 2:SUITE 204
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1047
Practice Address - Country:US
Practice Address - Phone:360-956-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA287712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1087410Medicaid
AB04535Medicare ID - Type Unspecified
E58193Medicare UPIN