Provider Demographics
NPI:1790741510
Name:DUNN, SANDRA (CNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1059
Mailing Address - Country:US
Mailing Address - Phone:330-344-6800
Mailing Address - Fax:330-344-6322
Practice Address - Street 1:676 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1059
Practice Address - Country:US
Practice Address - Phone:330-344-6800
Practice Address - Fax:330-344-6322
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-06373363LW0102X
OHRN.231635.COA1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2285414Medicaid
OHH202710Medicare PIN
OH2285414Medicaid