Provider Demographics
NPI:1952397150
Name:NUNNERY, JOAN A (APN-C)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:NUNNERY
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 SOUTHINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129
Mailing Address - Country:US
Mailing Address - Phone:440-885-2526
Mailing Address - Fax:
Practice Address - Street 1:7575 NORTHCLIFF AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144
Practice Address - Country:US
Practice Address - Phone:216-749-8276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05458700174400000X
OHNP-09205363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000548935OtherANTHEM
OH341847368039OtherCARESOURCE
OH2774752Medicaid
OH2774752Medicaid
NJ024960C3JMedicare PIN
NJS75185Medicare UPIN
OHNP24681Medicare PIN