Provider Demographics
NPI:1669472379
Name:DUNNING, MARY LEE (APN,RN,BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LEE
Last Name:DUNNING
Suffix:
Gender:F
Credentials:APN,RN,BC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:M.L.DUNNING ENTERPRISES
Mailing Address - City:OKAWVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62271-0397
Mailing Address - Country:US
Mailing Address - Phone:618-533-4166
Mailing Address - Fax:618-533-4166
Practice Address - Street 1:126 S LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3654
Practice Address - Country:US
Practice Address - Phone:618-533-4166
Practice Address - Fax:618-533-4166
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP37468Medicare UPIN
IL207342Medicare ID - Type Unspecified