Provider Demographics
NPI:1295102945
Name:DUNN, CHRISTINE A (NP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:DUNN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:1729 BURRSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1001
Mailing Address - Country:US
Mailing Address - Phone:315-798-1702
Mailing Address - Fax:315-798-1726
Practice Address - Street 1:34 CHENANGO AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1341
Practice Address - Country:US
Practice Address - Phone:315-853-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339653-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04269054Medicaid