Provider Demographics
NPI:1124056064
Name:DUNN, ANDREA VIRGINIA
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:VIRGINIA
Last Name:DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2401
Mailing Address - Country:US
Mailing Address - Phone:401-714-0603
Mailing Address - Fax:
Practice Address - Street 1:600 MOUNT PLEASANT AVE
Practice Address - Street 2:ATHLETICS DEPARTMENT
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1924
Practice Address - Country:US
Practice Address - Phone:401-456-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT002102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer