Provider Demographics
NPI:1821596677
Name:DUNN, LATRICE (RN)
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71058-0374
Mailing Address - Country:US
Mailing Address - Phone:318-458-5157
Mailing Address - Fax:
Practice Address - Street 1:1800 BUCKNER ST STE A120
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-429-2443
Practice Address - Fax:318-429-2440
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LARN139191163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health