Provider Demographics
NPI:1437305851
Name:KEES-DUNN, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KEES-DUNN
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:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-0587
Mailing Address - Country:US
Mailing Address - Phone:707-571-2215
Mailing Address - Fax:707-526-9672
Practice Address - Street 1:1710 MENDOCINO AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4317
Practice Address - Country:US
Practice Address - Phone:707-571-2215
Practice Address - Fax:707-526-9672
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAK0501041827101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAK0501041827OtherREGISTERED ADDICTION SPECIALIST