Provider Demographics
NPI:1174066344
Name:DUNAWAY, JOY
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:INDIAN MOUND
Mailing Address - State:TN
Mailing Address - Zip Code:37079-5352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3184 HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:INDIAN MOUND
Practice Address - State:TN
Practice Address - Zip Code:37079-5352
Practice Address - Country:US
Practice Address - Phone:931-627-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000069323164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse