MEDICARE: DAN SUN 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	363L00000X	Nurse Practitioner	71010750A	IN

General Provider Information

NPI Number	:	1295324523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN SUN NP

Provider Business Mailing Address
First Line	:	3013 N BELMONT DR
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-2101
Country	:	US
Telephone Number	:	765-201-0209
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1215
Country	:	US
Telephone Number	:	765-935-4440
Fax Number	:

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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Directions to “ DAN SUN NP” Practice Location

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