Provider Demographics
NPI:1659809648
Name:DUNBAR, ANITRA DEGRUSHA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANITRA
Middle Name:DEGRUSHA
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CHATRACE DR
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-4776
Mailing Address - Country:US
Mailing Address - Phone:318-359-2135
Mailing Address - Fax:
Practice Address - Street 1:7406 HIGHWAY 1 STE 101
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4204
Practice Address - Country:US
Practice Address - Phone:318-240-8515
Practice Address - Fax:318-240-8516
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09457363LF0000X
LARN109928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily