Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R23525 | ND |
NPI | 1053509273 |
---|---|
Provider Name | Sharon Dunkel |
First Address | Fargo, ND 58102-6050 |
Second Address | Fargo, ND 58102-6050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2007 |
Last Update Date | 09/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0257819 | NURSING CERTIFICATION (01) | ND |