Provider Demographics
NPI:1487886230
Name:DUNBAR, MONIQUE (NP)
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:3236 SPICY CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7162
Mailing Address - Country:US
Mailing Address - Phone:404-780-3096
Mailing Address - Fax:
Practice Address - Street 1:3236 SPICY CEDAR LN
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-7162
Practice Address - Country:US
Practice Address - Phone:404-780-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY547838163W00000X
GA220631363L00000X
GARN220631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1487886230Medicaid
GA1487886230OtherBCBS
NY1487886230Medicare Oscar/Certification