Provider Demographics
NPI:1679248421
Name:NUNN, TAMIKA ROCHELLE
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:ROCHELLE
Last Name:NUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 ASSELL AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-1704
Mailing Address - Country:US
Mailing Address - Phone:630-486-5699
Mailing Address - Fax:
Practice Address - Street 1:1121 ASSELL AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-1704
Practice Address - Country:US
Practice Address - Phone:630-486-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171W00000XOther Service ProvidersContractor