Provider Demographics
NPI:1952655904
Name:PEG DUNN CNM NURSE-MIDWIFERY SERVICE
Entity Type:Organization
Organization Name:PEG DUNN CNM NURSE-MIDWIFERY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:231-941-5568
Mailing Address - Street 1:515 W 14TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4059
Mailing Address - Country:US
Mailing Address - Phone:231-941-5568
Mailing Address - Fax:231-941-5578
Practice Address - Street 1:515 W 14TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4059
Practice Address - Country:US
Practice Address - Phone:231-941-5568
Practice Address - Fax:231-941-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704170453367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty