Basic Information
| Provider Information | |||||||||
| NPI: | 1487817136 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LISA DUNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 BARCELONA AVE | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349461022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724894598 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2250 HICKORY RD | ||||||||
| Address2: | SUITE | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008794471 | ||||||||
| FaxNumber: | 6108347525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | HOPE | ||||||||
| AuthorizedOfficialTitleorPosition: | CNA | ||||||||
| AuthorizedOfficialTelephone: | 7729714848 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | 131357 | FL | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.