Provider Demographics
NPI:1528164985
Name:CUNEO, JANICE J (NP)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:J
Last Name:CUNEO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:E
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30698
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-0698
Mailing Address - Country:US
Mailing Address - Phone:865-693-1000
Mailing Address - Fax:
Practice Address - Street 1:1900 N WINSTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3606
Practice Address - Country:US
Practice Address - Phone:865-693-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017138873363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200413480Medicaid
0907301Medicare ID - Type Unspecified
P80493Medicare UPIN