Provider Demographics
NPI:1417925058
Name:JUNG, DENNIS JOHN (CNP)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOHN
Last Name:JUNG
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 GALISTEO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2101
Mailing Address - Country:US
Mailing Address - Phone:505-995-4901
Mailing Address - Fax:505-989-6426
Practice Address - Street 1:2025 GALISTEO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2101
Practice Address - Country:US
Practice Address - Phone:505-995-4901
Practice Address - Fax:505-989-6426
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN27843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
2340212OtherUHC
NM98478Medicaid
QMYPR0069326OtherMOLINA
10009148OtherLOVELACE
201004971OtherPRESBYTERIAN HEALTH PLANS
NMNM006954OtherBCBS NM
QMYPR0069326OtherMOLINA
NM341412807Medicare PIN