Provider Demographics
NPI:1699243915
Name:DUNOVAN, MEGAN LORA (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LORA
Last Name:DUNOVAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2577 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5919
Mailing Address - Country:US
Mailing Address - Phone:970-247-8382
Mailing Address - Fax:970-259-4403
Practice Address - Street 1:604 S RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-2260
Practice Address - Country:US
Practice Address - Phone:505-334-2664
Practice Address - Fax:505-259-4403
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2024-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0008548363A00000X
NMPA2018-0092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant