Basic Information
Provider Information | |||||||||
NPI: | 1699834689 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DUNHAM | ||||||||
FirstName: | CHERYL | ||||||||
MiddleName: | RENEE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN BSN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DAEHLIN | ||||||||
OtherFirstName: | CHERYL | ||||||||
OtherMiddleName: | RENEE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN BSN | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1323 | ||||||||
Address2: | 515 W COURT ST | ||||||||
City: | PASCO | ||||||||
State: | WA | ||||||||
PostalCode: | 99301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5095472204 | ||||||||
FaxNumber: | 5095428836 | ||||||||
Practice Location | |||||||||
Address1: | 720 W COURT ST | ||||||||
Address2: | #8 | ||||||||
City: | PASCO | ||||||||
State: | WA | ||||||||
PostalCode: | 99301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5095456506 | ||||||||
FaxNumber: | 5095460520 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/06/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | RN00066266 | WA | Y |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.