Provider Demographics
NPI:1134157514
Name:DUNSTAN, MARILYN (ARNP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:DUNSTAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CRESTVUE AVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:KS
Mailing Address - Zip Code:66956-2407
Mailing Address - Country:US
Mailing Address - Phone:785-378-3137
Mailing Address - Fax:785-378-3450
Practice Address - Street 1:102 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:KS
Practice Address - Zip Code:66956-2202
Practice Address - Country:US
Practice Address - Phone:785-378-3511
Practice Address - Fax:785-378-3919
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEKS1441086Medicaid
KS648020OtherFIRSTGUARD
KS160951OtherBLUE CROSS BLUE SHIELD KS
NEKS1441086Medicaid