Provider Demographics
NPI:1801899661
Name:DUNN, CONNIE RAY (APRN,CDE,BC-ADM)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:RAY
Last Name:DUNN
Suffix:
Gender:F
Credentials:APRN,CDE,BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7167
Mailing Address - Country:US
Mailing Address - Phone:573-815-7146
Mailing Address - Fax:573-815-7143
Practice Address - Street 1:1705 E BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7167
Practice Address - Country:US
Practice Address - Phone:573-815-7146
Practice Address - Fax:573-815-7143
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120864363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P38693Medicare UPIN