Provider Demographics
NPI:1326404112
Name:DUNN, ALEXIS A (LMBT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:DUNN
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MOUNT CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-9763
Mailing Address - Country:US
Mailing Address - Phone:828-505-3905
Mailing Address - Fax:828-505-4158
Practice Address - Street 1:91 MOUNT CARMEL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-9763
Practice Address - Country:US
Practice Address - Phone:828-505-3905
Practice Address - Fax:828-505-4158
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13171OtherLICENSE