Provider Demographics
NPI:1689058265
Name:DUNLOW, STEPHANIE DICKENS (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DICKENS
Last Name:DUNLOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4940
Mailing Address - Country:US
Mailing Address - Phone:252-535-4343
Mailing Address - Fax:252-308-0977
Practice Address - Street 1:63 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4940
Practice Address - Country:US
Practice Address - Phone:252-535-4343
Practice Address - Fax:252-308-0977
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173291363L00000X
NC5007774363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner