Provider Demographics
NPI:1396188488
Name:ZUNKEL, NANETTE G (DNP/FNP)
Entity Type:Individual
Prefix:DR
First Name:NANETTE
Middle Name:G
Last Name:ZUNKEL
Suffix:
Gender:F
Credentials:DNP/FNP
Other - Prefix:
Other - First Name:NAN
Other - Middle Name:G
Other - Last Name:ZUNKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP/FNP
Mailing Address - Street 1:619 NW 6TH AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3991
Mailing Address - Country:US
Mailing Address - Phone:971-940-3149
Mailing Address - Fax:
Practice Address - Street 1:619 NW 6TH AVE FL 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3991
Practice Address - Country:US
Practice Address - Phone:971-940-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR095007085RN163W00000X
WARN61280814163W00000X
WAAP60770487363L00000X
OR201505394NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022959Medicaid
OR500694451Medicaid