Provider Demographics
NPI:1194368316
Name:DUNHAM, ANNY LOU MANDAPAT (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:ANNY LOU
Middle Name:MANDAPAT
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ANNY LOU
Other - Middle Name:LUMANOG
Other - Last Name:MANDAPAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13310 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1816
Mailing Address - Country:US
Mailing Address - Phone:405-513-7333
Mailing Address - Fax:
Practice Address - Street 1:1142 SW 104TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139
Practice Address - Country:US
Practice Address - Phone:405-691-3100
Practice Address - Fax:405-691-3106
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily