Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704124961 | MI |
NPI | 1073958344 |
---|---|
Provider Name | Deborah Sue Dunn |
First Address | Plymouth, MI 48170-5064 |
Second Address | Plymouth, MI 48170-5064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 01/05/2013 |