Provider Demographics
NPI:1790769271
Name:DUNN, MARILYN ELEANOR (FNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ELEANOR
Last Name:DUNN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SISTER MARILYN
Other - Middle Name:ELEANOR
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:175 ROUTE 340
Mailing Address - Street 2:MEDICAL RM 312
Mailing Address - City:SPARKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10976-1041
Mailing Address - Country:US
Mailing Address - Phone:845-359-3311
Mailing Address - Fax:845-359-3310
Practice Address - Street 1:175 ROUTE 340
Practice Address - Street 2:MEDICAL RM 312
Practice Address - City:SPARKILL
Practice Address - State:NY
Practice Address - Zip Code:10976-1041
Practice Address - Country:US
Practice Address - Phone:845-359-3311
Practice Address - Fax:845-359-3310
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY94V521Medicare ID - Type UnspecifiedFNP