Basic Information
| Provider Information | |||||||||
| NPI: | 1124735899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUNAMAKER | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1227 ANSEL RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441083323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164210662 | ||||||||
| FaxNumber: | 2164210911 | ||||||||
| Practice Location | |||||||||
| Address1: | 1227 ANSEL RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441083323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164210662 | ||||||||
| FaxNumber: | 2164210911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2022 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.2005038 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 1275598419 | 05 | OH | MEDICAID |