Provider Demographics
NPI:1306025846
Name:DUNN, JENNIFER FAY
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:FAY
Last Name:DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:FAY
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:234 W MAIN ST
Mailing Address - Street 2:#209
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4645
Mailing Address - Country:US
Mailing Address - Phone:262-744-1073
Mailing Address - Fax:
Practice Address - Street 1:234 W MAIN ST
Practice Address - Street 2:#209
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4645
Practice Address - Country:US
Practice Address - Phone:262-744-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI106452030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39918800Medicaid