Provider Demographics
NPI:1356613921
Name:DUNLAP, CINDY LEE (PA)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:LEE
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LEE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1705 E 19TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5405
Mailing Address - Country:US
Mailing Address - Phone:918-748-7585
Mailing Address - Fax:918-748-7539
Practice Address - Street 1:1705 E 19TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5405
Practice Address - Country:US
Practice Address - Phone:918-748-7585
Practice Address - Fax:918-748-7539
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant