Provider Demographics
NPI:1073120325
Name:DUNN, SALLY ROSE (NP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ROSE
Last Name:DUNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ROSE
Other - Last Name:MCSHANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR STE 4230
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-948-8556
Practice Address - Fax:317-948-7290
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010369A363LP2300X, 363LP0200X
IN28196065A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse