Provider Demographics
NPI:1205866969
Name:DUNSMUIR, LARLENE M (FNP)
Entity Type:Individual
Prefix:
First Name:LARLENE
Middle Name:M
Last Name:DUNSMUIR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:1321 NE 99TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9436
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:503-215-4055
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150027NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00294105OtherRR MEDICARE
OR084962Medicaid
ORP00294105OtherRR MEDICARE
ORR157941Medicare PIN
ORR153394Medicare PIN
ORR139065Medicare PIN
ORR118391Medicare PIN
ORR154160Medicare PIN
ORR155393Medicare PIN
ORR157959Medicare PIN
ORR140430Medicare PIN