Provider Demographics
NPI:1003904418
Name:DUNN, PANTEA NOSRAT (MSN PNP)
Entity Type:Individual
Prefix:MRS
First Name:PANTEA
Middle Name:NOSRAT
Last Name:DUNN
Suffix:
Gender:F
Credentials:MSN PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 EXPOSITION BLVD
Mailing Address - Street 2:BLDG 700
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-736-3408
Mailing Address - Fax:916-233-4171
Practice Address - Street 1:1528 EUREKA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3047
Practice Address - Country:US
Practice Address - Phone:916-736-6644
Practice Address - Fax:916-774-0143
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534431363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA534431OtherPNP LICENSE