Basic Information
| Provider Information | |||||||||
| NPI: | 1174570626 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NUNAN | ||||||||
| FirstName: | CINDY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 E. NEW YORK AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERS POINT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096533265 | ||||||||
| FaxNumber: | 6099264311 | ||||||||
| Practice Location | |||||||||
| Address1: | 4450 E. BLACK HORSE PIKE | ||||||||
| Address2: | UNIT 3972 | ||||||||
| City: | MAYS LANDING | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093656217 | ||||||||
| FaxNumber: | 6099264311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26NJ00101900 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0091618 | 05 | NJ | MEDICAID |