Provider Demographics
NPI:1982718821
Name:DUNAVAN, SANDRA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:DUNAVAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2602
Mailing Address - Country:US
Mailing Address - Phone:620-285-6041
Mailing Address - Fax:620-285-6194
Practice Address - Street 1:200 E 8TH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2602
Practice Address - Country:US
Practice Address - Phone:620-285-6041
Practice Address - Fax:620-285-6194
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74474363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P53373Medicare UPIN