Provider Demographics
NPI:1205878592
Name:DUNDAS, JAN ELIZABETH (MSN, C-PNP)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:ELIZABETH
Last Name:DUNDAS
Suffix:
Gender:F
Credentials:MSN, C-PNP
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, C-PNP
Mailing Address - Street 1:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:713-523-4897
Practice Address - Street 1:4550 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705
Practice Address - Country:US
Practice Address - Phone:409-832-1924
Practice Address - Fax:713-523-4897
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588314363LP0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080462703Medicaid
TX080462703Medicaid