Provider Demographics
NPI:1942454194
Name:PANNUNZIO, DUANE JOHN SR
Entity Type:Individual
Prefix:MR
First Name:DUANE
Middle Name:JOHN
Last Name:PANNUNZIO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DUANE
Other - Middle Name:JOHN
Other - Last Name:PANNUNZIO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:369 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1456
Mailing Address - Country:US
Mailing Address - Phone:330-519-1824
Mailing Address - Fax:
Practice Address - Street 1:369 PORTER AVE
Practice Address - Street 2:N/A
Practice Address - City:CAMPBELL
Practice Address - State:OH
Practice Address - Zip Code:44405-1456
Practice Address - Country:US
Practice Address - Phone:330-519-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN214395163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse