MEDICARE: PRISCILLA DUNHAM PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	201369	ND

General Provider Information

NPI Number	:	1811707730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA DUNHAM PMHNP

Provider Business Mailing Address
First Line	:	914 S 12TH ST STE 101
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-5941
Country	:	US
Telephone Number	:	701-255-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 S 12TH ST STE 101
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-5941
Country	:	US
Telephone Number	:	701-255-4242
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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