Basic Information
Provider Information
NPI: 1861874729
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUNN
FirstName: IRENE
MiddleName: LOUISA
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4849 N MESA ST STE 201
Address2:  
City: EL PASO
State: TX
PostalCode: 799125919
CountryCode: US
TelephoneNumber: 9153516600
FaxNumber: 9153516601
Practice Location
Address1: 11160 MONTWOOD DR
Address2:  
City: EL PASO
State: TX
PostalCode: 799364240
CountryCode: US
TelephoneNumber: 9154377207
FaxNumber: 9153516601
Other Information
ProviderEnumerationDate: 06/26/2015
LastUpdateDate: 08/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XAP128692TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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