Provider Demographics
NPI:1316800675
Name:DUNN, KATINA INEZ
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:INEZ
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 1:3844 JASON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-2005
Mailing Address - Country:US
Mailing Address - Phone:208-242-3044
Mailing Address - Fax:208-904-0494
Practice Address - Street 1:707 N 7TH AVE STE D
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5796
Practice Address - Country:US
Practice Address - Phone:208-242-3044
Practice Address - Fax:208-904-0494
Is Sole Proprietor?:No
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator