Individual
DR. MARK M NUNLIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
331 OLCOTT DR, STE U3, WHITE RIVER JUNCTION, VT 05001-9601
(802) 295-6132
(802) 295-1358
Mailing address
331 OLCOTT DR, STE U3, WHITE RIVER JUNCTION, VT 05001-9601
(802) 295-6132
(802) 295-1358
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042-0006923
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5593
—
VT
05
—
8000076
—
VT
01
—
Y400215412
MEDICARE PTAN
VT
Enumeration date
06/16/2005
Last updated
06/11/2015
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