Provider Demographics
NPI:1104078138
Name:DUNN, LESLIE ROBIN (CNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ROBIN
Last Name:DUNN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ROBIN
Other - Last Name:BURGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:500 LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-5512
Mailing Address - Country:US
Mailing Address - Phone:937-578-7792
Mailing Address - Fax:614-937-2467
Practice Address - Street 1:500 LONDON AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5512
Practice Address - Country:US
Practice Address - Phone:937-578-2020
Practice Address - Fax:937-578-2019
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.306516163W00000X
OHAPRN.CNP.10285363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2933080Medicaid
OHNP30701Medicare PIN