Provider Demographics
NPI:1518079037
Name:DUNHAM, DEBORAH JO (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JO
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21229 OLEAN BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6719
Mailing Address - Country:US
Mailing Address - Phone:941-625-6223
Mailing Address - Fax:941-627-2680
Practice Address - Street 1:21229 OLEAN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6719
Practice Address - Country:US
Practice Address - Phone:941-625-6223
Practice Address - Fax:941-627-2680
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2186302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S69732Medicare UPIN
E1842ZMedicare ID - Type Unspecified