MEDICARE: MICHAEL J NUNNERY CPO

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	1744P3200X	Prosthetics Case Management	CPO0004	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	401254	OTHER	RI	BLUECHIP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	225148	OTHER	RI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1316944010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J NUNNERY CPO

Provider Business Mailing Address
First Line	:	7408 POST RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-3217
Country	:	US
Telephone Number	:	401-294-4210
Fax Number	:	401-294-3104

Provider Business Practice Location Address
First Line	:	7408 POST RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-3217
Country	:	US
Telephone Number	:	401-294-4210
Fax Number	:	401-294-3104

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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