Provider Demographics
NPI:1417516048
Name:DUNBAR, JESSICA JO-ANNE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JO-ANNE
Last Name:DUNBAR
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 1:5515 SAN CLEMENTE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2117
Mailing Address - Country:US
Mailing Address - Phone:830-591-8326
Mailing Address - Fax:
Practice Address - Street 1:5515 SAN CLEMENTE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2117
Practice Address - Country:US
Practice Address - Phone:830-591-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX882540163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse