Provider Demographics
NPI:1093724486
Name:NUNNALLY, L ANN (MD)
Entity Type:Individual
Prefix:
First Name:L
Middle Name:ANN
Last Name:NUNNALLY
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 1:1436 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1094
Mailing Address - Country:US
Mailing Address - Phone:330-670-6191
Mailing Address - Fax:330-670-6193
Practice Address - Street 1:839 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2460
Practice Address - Country:US
Practice Address - Phone:330-535-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061531207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0852564Medicaid
NC0025517OtherLICENSE
OH35061531OtherLICENSE
OH35061531OtherLICENSE
IL0852564Medicaid
AN9614783OtherDEA