Basic Information
| Provider Information | |||||||||
| NPI: | 1043606577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNSON | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DUNSON | ||||||||
| OtherFirstName: | TERRI | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 708760 | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840708760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013529500 | ||||||||
| FaxNumber: | 8013527976 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 MEDICAL CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | SELMA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367016748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3344186646 | ||||||||
| FaxNumber: | 3344186647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2015 | ||||||||
| LastUpdateDate: | 04/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 1088422 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.