MARY INEZ NUNCHUCK (NPI# 1316028616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1316028616 |
Entity Type | Individual |
Full Name | MARY INEZ NUNCHUCK |
Credential | D.O. |
Practice Address |
1717 Taylor Ave Racine WI 53403-2405 |
Practice Telephone | 2626386744 |
Practice Fax Number | 2626386540 |
Mailing Telephone | 2626386744 |
Mailing Fax Number | 2626386540 |
Enumeration Date | 2006-10-17 |
Last Update Date | 2020-07-07 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
377260021 | WI | Allopathic & Osteopathic Physicians |
Street Address |
1717 TAYLOR AVE |
City | RACINE |
State | WI |
Zip Code | 53403-2405 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356441018 | Susan F Mickel | Psychologist | 1717 Taylor Ave, Racine, WI 53403-2405 | 2006-09-23 |
1811595671 | Wallace Edward Brandies Jr. | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2020-10-14 |
1811503204 | Sarah Moran | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2020-09-21 |
1013539477 | Kelly Jean Smith | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2020-05-08 |
1417577230 | Alexandra Kim Kies | Social Worker | 1717 Taylor Ave, Racine, WI 53403-2405 | 2020-04-22 |
1336785336 | Selena Lamont Letteer | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2019-11-25 |
1841832474 | Dora Ann Caldwell | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2019-10-15 |
1043876451 | Darren L Taylor | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2019-05-13 |
1689230179 | Kathleen B Campeau | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2019-05-10 |
1689131534 | Melissa Hellen | Social Worker | 1717 Taylor Ave, Racine, WI 53403-2405 | 2019-02-27 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124676259 | Quality Care LLC | Clinic/Center | 2051 Mead St, Racine, WI 53403 | 2019-09-02 |
1073999355 | Wisconsin Lutheran Child & Family Service, Inc. | Social Worker | 6150 Taylor Avenue, Racine, WI 53403 | 2015-08-10 |
1457780496 | Pheynell Branch | Counselor | 1650 Wasington Ave, Racine, WI 53403 | 2013-11-08 |
1811278054 | Michelle Gloria Parisot | Psychologist | 1320 Wisconsin Ave., Racine, WI 53403 | 2011-09-01 |
1720372022 | Katie Hagen | Social Worker | 1717 Taylor Avenue, Racine, WI 53403 | 2011-06-03 |
1043431570 | Rita S Harris | Physical Therapy Assistant | Lakeshore Manor 1320 Wisconsin Avenue, Racine, WI 53403 | 2007-05-01 |
1336281336 | Linda J Hockensmith | Occupational Therapist | 4214 Sheridan Road, Racine, WI 53403 | 2007-02-13 |
1851447387 | Richard John Kemper | Dentist | 1509 Washington Ave, Racine, WI 53403 | 2007-01-26 |
1689760332 | Lester Leslie Higgenbottom | Counselor | 1820 Arlington Ave, Racine, WI 53403 | 2006-10-04 |
1114942315 | Access Medical Center, LLC | Clinic/Center | 4216 Old Green Bay Rd, Racine, WI 53403 | 2006-07-12 |
Find all providers in zip 53403 |
Taxonomy Code | 2084P0802X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Addiction Psychiatry |
Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790837128 | Milwaukee Health Services System, LLC | Psychiatry & Neurology | 4800 S. 10th Street, Milwaukee, WI 53221-2412 | 2007-01-17 |
1164432118 | Tellurian, Inc. | Psychiatry & Neurology | 1053 Williamson St, Madison, WI 53703-3525 | 2006-08-09 |
1114377702 | Valdez & Soto, LLC | Psychiatry & Neurology | 1001 Cecelia Dr Ste 200, Pewaukee, WI 53072-2546 | 2016-06-15 |
1487018834 | Bryan Hybki | Psychiatry & Neurology | Uw Hospitals & Clinics 600 Highland Ave, Madison, WI 53792-1000 | 2016-04-12 |
1588921696 | Mohammed Abbas Rahemtulla | Psychiatry & Neurology | 903 Mineral Point Ave, Janesville, WI 53548-2970 | 2012-04-13 |
1285672360 | Virginia M. Linabury | Psychiatry & Neurology | 250 W Coventry Ct, Suite 209, Glendale, WI 53217-3972 | 2006-06-02 |
1235109638 | Carolyn Jean Reabe | Psychiatry & Neurology | 3425 Superior Ave, Sheboygan, WI 53081-1863 | 2006-01-26 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.