Healthcare Provider Details

I. General information

NPI: 1093736274
Provider Name (Legal Business Name): NUNNERY ORTHOTIC & PROSTHETIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 POST RD
NORTH KINGSTOWN RI
02852-3217
US

IV. Provider business mailing address

7408 POST RD
NORTH KINGSTOWN RI
02852-3217
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-4210
  • Fax: 401-294-3104
Mailing address:
  • Phone: 401-294-4210
  • Fax: 401-294-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCPO0004
License Number StateRI

VIII. Authorized Official

Name: MICHAEL J. NUNNERY
Title or Position: OWNER/ORTHOTIST PROSTHETIST
Credential: CPO
Phone: 401-294-4210