Provider Demographics
NPI:1013153105
Name:DUNGAN, PAMELA LEAH (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LEAH
Last Name:DUNGAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 88TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55808-1524
Mailing Address - Country:US
Mailing Address - Phone:218-491-5864
Mailing Address - Fax:218-249-2451
Practice Address - Street 1:1429 88TH AVE W
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55808-1524
Practice Address - Country:US
Practice Address - Phone:218-491-5864
Practice Address - Fax:218-249-2451
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 051054-5164W00000X
MN2488433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse