Provider Demographics
NPI:1275882987
Name:DUNN, MARIE JACKSON (CRNA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:JACKSON
Last Name:DUNN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2505
Mailing Address - Country:US
Mailing Address - Phone:336-406-5216
Mailing Address - Fax:
Practice Address - Street 1:2120 QUEEN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2505
Practice Address - Country:US
Practice Address - Phone:336-406-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered