Provider Demographics
NPI:1639826316
Name:DUNIVAN, CASSANDRA LEANN (ARNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEANN
Last Name:DUNIVAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:10 HARMONY CT
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-2216
Mailing Address - Country:US
Mailing Address - Phone:641-217-1277
Mailing Address - Fax:
Practice Address - Street 1:1321 GEAR AVE
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655
Practice Address - Country:US
Practice Address - Phone:319-768-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF02220824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily