Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 71010369A | IN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 71010369A | IN |
NPI | 1073120325 |
---|---|
Provider Name | Sally Rose Dunn |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2020 |
Last Update Date | 17/12/2020 |