Provider Demographics
NPI:1316944010
Name:NUNNERY, MICHAEL J (CPO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:NUNNERY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7408 POST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3217
Mailing Address - Country:US
Mailing Address - Phone:401-294-4210
Mailing Address - Fax:401-294-3104
Practice Address - Street 1:7408 POST RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3217
Practice Address - Country:US
Practice Address - Phone:401-294-4210
Practice Address - Fax:401-294-3104
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICPO00041744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI401254OtherBLUECHIP
RI5580001Medicaid
RI225148OtherBLUE CROSS BLUE SHIELD
RI5580001Medicaid