Basic Information
Provider Information
NPI: 1275851503
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NUNEZ
FirstName: JENNIFER
MiddleName: MARIA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.-PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2511 OLD CORNWALLIS RD STE 200
Address2:  
City: DURHAM
State: NC
PostalCode: 277131869
CountryCode: US
TelephoneNumber: 9199325700
FaxNumber: 9199336881
Practice Location
Address1: 2511 OLD CORNWALLIS RD STE 200
Address2:  
City: DURHAM
State: NC
PostalCode: 277131869
CountryCode: US
TelephoneNumber: 9199325700
FaxNumber: 9199336881
Other Information
ProviderEnumerationDate: 05/11/2010
LastUpdateDate: 02/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X2010-00656NCY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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