Provider Demographics
NPI:1679012504
Name:NUNAG, LERIZZA D (APRN)
Entity Type:Individual
Prefix:
First Name:LERIZZA
Middle Name:D
Last Name:NUNAG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 STATE HIGHWAY 388
Mailing Address - Street 2:
Mailing Address - City:GOULD
Mailing Address - State:AR
Mailing Address - Zip Code:71643-9634
Mailing Address - Country:US
Mailing Address - Phone:870-850-8673
Mailing Address - Fax:870-850-7938
Practice Address - Street 1:2540 STATE HIGHWAY 388
Practice Address - Street 2:
Practice Address - City:GOULD
Practice Address - State:AR
Practice Address - Zip Code:71643-9634
Practice Address - Country:US
Practice Address - Phone:870-850-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005047363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology