Basic Information
| Provider Information | |||||||||
| NPI: | 1417371626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNLAP | ||||||||
| FirstName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 UPTOWN BLVD NE | ||||||||
| Address2: | STE 360W | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871104204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058559805 | ||||||||
| FaxNumber: | 5058489468 | ||||||||
| Practice Location | |||||||||
| Address1: | 6400 UPTOWN BLVD NE | ||||||||
| Address2: | STE 360W | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871104204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058559805 | ||||||||
| FaxNumber: | 5058489468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2014 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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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 | 163WS0200X | R-36198 | NM | Y | Nursing Service Providers | Registered Nurse | School |
No ID Information.