Healthcare Provider Details

I. General information

NPI: 1093724486
Provider Name (Legal Business Name): L ANN NUNNALLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 E MARKET ST
AKRON OH
44305-2460
US

IV. Provider business mailing address

1436 RESERVE DR
AKRON OH
44333-1094
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-9191
  • Fax:
Mailing address:
  • Phone: 330-670-6191
  • Fax: 330-670-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35061531
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: