MEDICARE: MRS. DAWN MARIE GUNDERSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	71001314A	IN

General Provider Information

NPI Number	:	1174747505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN MARIE GUNDERSON NP

Provider Business Mailing Address
First Line	:	1040 SIERRA DR STE 400
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7241
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 ALLIANCE DR STE A
Second Line	:
City	:	CAMBY
State	:	IN
Zip	:	46113-8837
Country	:	US
Telephone Number	:	317-856-7083
Fax Number	:	317-856-7332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	03/22/2021

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