Provider Demographics
NPI:1407213010
Name:DUNIVANT, MARGENE
Entity Type:Individual
Prefix:MS
First Name:MARGENE
Middle Name:
Last Name:DUNIVANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 W 104TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-1914
Mailing Address - Country:US
Mailing Address - Phone:918-282-2502
Mailing Address - Fax:
Practice Address - Street 1:4010 W 104TH ST S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-1914
Practice Address - Country:US
Practice Address - Phone:918-282-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist