Provider Demographics
NPI:1962144956
Name:DUNNING, JUSTICE ROSE (LPN)
Entity type:Individual
Prefix:
First Name:JUSTICE
Middle Name:ROSE
Last Name:DUNNING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6269 1323RD ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-7003
Mailing Address - Country:US
Mailing Address - Phone:651-248-1029
Mailing Address - Fax:
Practice Address - Street 1:N6269 1323RD ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:WI
Practice Address - Zip Code:54021-7003
Practice Address - Country:US
Practice Address - Phone:651-558-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN784892164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse