MEDICARE: DR. JANE B. NUNNELEE RN, PHD, GNP

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	374T00000X	Religious Nonmedical Nursing Personnel	232694	TX

General Provider Information

NPI Number	:	1548388895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE B. NUNNELEE RN, PHD, GNP

Provider Business Mailing Address
First Line	:	9841 SHADYDALE LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-4303
Country	:	US
Telephone Number	:	214-553-9777
Fax Number	:	214-553-9777

Provider Business Practice Location Address
First Line	:	9841 SHADYDALE LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-4303
Country	:	US
Telephone Number	:	214-553-9777
Fax Number	:	214-553-9777

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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