1669472379 NPI number — MRS. MARY LEE DUNNING APN,RN,BC

Table of content: MRS. MARY LEE DUNNING APN,RN,BC (NPI 1669472379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669472379 NPI number — MRS. MARY LEE DUNNING APN,RN,BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNNING
Provider First Name:
MARY
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN,RN,BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669472379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 397
Provider Second Line Business Mailing Address:
M.L.DUNNING ENTERPRISES
Provider Business Mailing Address City Name:
OKAWVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62271-0397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-533-4166
Provider Business Mailing Address Fax Number:
618-533-4166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 S LINCOLN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62801-3654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-533-4166
Provider Business Practice Location Address Fax Number:
618-533-4166
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com