Provider Demographics
NPI:1073516779
Name:DUNN, MARY CATHERINE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:DUNN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 WILDWOOD VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4807
Mailing Address - Country:US
Mailing Address - Phone:615-483-0912
Mailing Address - Fax:
Practice Address - Street 1:2601 BRANSFORD AVE ELL OFFICE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204
Practice Address - Country:US
Practice Address - Phone:615-259-3282
Practice Address - Fax:615-214-8655
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04457363LF0000X
TN6096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1470589Medicaid
LA4H329CH71Medicare ID - Type Unspecified
LAQ35827Medicare UPIN