MEDICARE: MS. DOROTHY JOY UNGER CFNP

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	R072343-6	MN

General Provider Information

NPI Number	:	1871543967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHY JOY UNGER CFNP

Provider Business Mailing Address
First Line	:	901 9TH ST N
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2348
Country	:	US
Telephone Number	:	218-748-7480
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 9TH ST N
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2348
Country	:	US
Telephone Number	:	218-748-7480
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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