Provider Demographics
NPI:1255316840
Name:DUNN, JONATHAN RICHARD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:DUNN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 WOODMONT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9638
Mailing Address - Country:US
Mailing Address - Phone:336-703-1233
Mailing Address - Fax:
Practice Address - Street 1:5030 WOODMONT RIDGE CT
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9638
Practice Address - Country:US
Practice Address - Phone:336-703-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141399367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051553Medicaid
NC2602426Medicare PIN