Provider Demographics
NPI:1154300390
Name:DUNAWAY, CAROL LYNN (APRN-BC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:GILCHRIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:10792 S SANDY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6469
Mailing Address - Country:US
Mailing Address - Phone:520-979-2554
Mailing Address - Fax:
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:520-629-1864
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 1230363LF0000X
AZRN110558363LF0000X
AZAP5414363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP35008Medicare UPIN