Provider Demographics
NPI:1740688787
Name:DUNDAS, KATHLEEN (RN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:DUNDAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 E DEER VALLEY DR
Mailing Address - Street 2:2402
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4126
Mailing Address - Country:US
Mailing Address - Phone:480-227-1262
Mailing Address - Fax:
Practice Address - Street 1:5350 E DEER VALLEY DR
Practice Address - Street 2:2402
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-4126
Practice Address - Country:US
Practice Address - Phone:480-227-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ074616163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse