Provider Demographics
NPI:1518112697
Name:DUNN, AMBERLY MICHELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:AMBERLY
Middle Name:MICHELLE
Last Name:DUNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:AMBERLY
Other - Middle Name:MICHELLE
Other - Last Name:HASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMBERLY HASS, CRNP
Mailing Address - Street 1:10390 DEMOCRACY LANE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-219-2571
Mailing Address - Fax:703-324-7092
Practice Address - Street 1:10390 DEMOCRACY LANE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-219-2571
Practice Address - Fax:703-324-7092
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169933363LP0808X
VA0024170947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD440049600Medicaid