Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP018603 | PA |
NPI | 1023502895 |
---|---|
Provider Name | Brenda Dunmire |
First Address | New Kensington, PA 15068-8308 |
Second Address | Pittsburgh, PA 15224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 18/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14273761 | CAQH (01) | PA |
PENDING | (05) | PA |