Provider Demographics
NPI:1003929985
Name:DENOUDEN- DUNN, LAURA B (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:DENOUDEN- DUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28646-0785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:614 HOWARD ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-5287
Practice Address - Country:US
Practice Address - Phone:828-262-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00513207R00000X
MO116672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
114977OtherBLUE CROSS
MO203782909Medicaid
P00371885Medicare PIN
010011890Medicare PIN
114977OtherBLUE CROSS
G39070Medicare UPIN
110168919Medicare PIN