1942300637 NPI number — MRS. GINA SUZANNE DUNSE RD LMNT

Table of content: MRS. GINA SUZANNE DUNSE RD LMNT (NPI 1942300637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942300637 NPI number — MRS. GINA SUZANNE DUNSE RD LMNT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNSE
Provider First Name:
GINA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD LMNT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUNNELL
Provider Other First Name:
GINA
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942300637
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 74
Provider Second Line Business Mailing Address:
1114 W. FOURTH ST.
Provider Business Mailing Address City Name:
ALMA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68920-0074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-928-2154
Provider Business Mailing Address Fax Number:
308-928-2154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1114 4TH ST
Provider Second Line Business Practice Location Address:
1114 W. FOURTH ST.
Provider Business Practice Location Address City Name:
ALMA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68920-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-928-2154
Provider Business Practice Location Address Fax Number:
308-928-2154
Provider Enumeration Date:
09/23/2006

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: 133V00000X , with the licence number:  682 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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