Provider Demographics
NPI:1053661405
Name:DUNDORE, REBECCA (CLD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DUNDORE
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23219 BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:TX
Mailing Address - Zip Code:77861-5431
Mailing Address - Country:US
Mailing Address - Phone:936-394-2392
Mailing Address - Fax:
Practice Address - Street 1:23219 BRAZOS AVE
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:TX
Practice Address - Zip Code:77861-5431
Practice Address - Country:US
Practice Address - Phone:936-394-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula