Provider Demographics
NPI:1073554663
Name:DUNLAP, ANDREA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4300 SAPPHIRE CT
Mailing Address - Street 2:STE 110
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9075
Mailing Address - Country:US
Mailing Address - Phone:252-830-7540
Mailing Address - Fax:252-752-0074
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:SUITE L
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3326
Practice Address - Country:US
Practice Address - Phone:252-335-0803
Practice Address - Fax:252-331-1796
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001002787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
[13920Medicare UPIN
TN3668099Medicare ID - Type Unspecified