MEDICARE: L ANN NUNNALLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	35061531	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0025517	OTHER	NC	LICENSE
3	35061531	OTHER	OH	LICENSE

General Provider Information

NPI Number	:	1093724486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	L ANN NUNNALLY MD

Provider Business Mailing Address
First Line	:	1436 RESERVE DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-1094
Country	:	US
Telephone Number	:	330-670-6191
Fax Number	:	330-670-6193

Provider Business Practice Location Address
First Line	:	839 E MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-2460
Country	:	US
Telephone Number	:	330-535-9191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/07/2023

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Directions to “ L ANN NUNNALLY MD” Practice Location

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