Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD2010-0175 | NM |
N | 207VG0400X | Gynecologist | 2007-00553 | NC |
N | 207VG0400X | Gynecologist | MD2010-0175 | NM |
NPI | 1417007808 |
---|---|
Provider Name | Dr. Gena Colleen Dunivan |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 14/08/2014 |