Provider Demographics
NPI:1215689005
Name:DUNBAR, MENW WADAH
Entity type:Individual
Prefix:
First Name:MENW
Middle Name:WADAH
Last Name:DUNBAR
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 1:5100 S NEVADA AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2277
Mailing Address - Country:US
Mailing Address - Phone:507-573-1251
Mailing Address - Fax:
Practice Address - Street 1:5100 S NEVADA AVE APT 104
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2277
Practice Address - Country:US
Practice Address - Phone:507-573-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD87-3660373Medicaid