1699834689 NPI number — MS. CHERYL RENEE DUNHAM RN BSN

Table of content: MS. CHERYL RENEE DUNHAM RN BSN (NPI 1699834689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699834689 NPI number — MS. CHERYL RENEE DUNHAM RN BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNHAM
Provider First Name:
CHERYL
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAEHLIN
Provider Other First Name:
CHERYL
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN BSN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699834689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1323
Provider Second Line Business Mailing Address:
515 W COURT ST
Provider Business Mailing Address City Name:
PASCO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-547-2204
Provider Business Mailing Address Fax Number:
509-542-8836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 W COURT ST
Provider Second Line Business Practice Location Address:
#8
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-545-6506
Provider Business Practice Location Address Fax Number:
509-546-0520
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0809X , with the licence number:  RN00066266 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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