Provider Demographics
NPI:1316148802
Name:DUNN, ELISA (NP)
Entity type:Individual
Prefix:MS
First Name:ELISA
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 W 102ND ST
Mailing Address - Street 2:#4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8443
Mailing Address - Country:US
Mailing Address - Phone:212-316-5474
Mailing Address - Fax:
Practice Address - Street 1:1775 BROADWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1903
Practice Address - Country:US
Practice Address - Phone:212-649-5502
Practice Address - Fax:212-844-1928
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily